Impact of access and nonaccess site bleeding measured by Bleeding Academic Research Consortium (BARC) criteria on long-term outcome in patients treated with primary percutaneous coronary intervention

Abstract

Purpose: The relative contribution of access versus nonaccess site bleeding to subsequent mortality of pts treated with primary percutaneous coronary intervention (PCI) is poorly understood. The purpose of this study was to investigate the relative incidence of access and nonaccess site bleeding and the association of these events with 1-year mortality in unselected pts with acute ST-elevation myocardial infarction (STEMI) undergoing primary PCI. Methods: We analyzed data about in-hospital bleeding of all consecutive STEMI pts underwent primary PCI between 8/2009 and 1/2011 enrolled in a prospective registry of a high volume tertiary center. Bleeding access and nonaccess site events were assessed using Bleeding Academic Research Consortium (BARC) criteria. BARC class ≥ 2 bleeding were taken into consideration. The primary outcome was 1-year mortality. Results: Of the 1808 STEMI pts with primary PCI, 115 (6.4%) experienced a BARC class ≥ 2 bleeding. Access site bleeding occurred in 3.7%, whereas the rate of nonaccess site bleeding was 2.8%. Unadjusted 1-year mortality rate was more than 2-fold higher in pts with nonaccess versus access site bleeding (Table). After multivariable adjustment for demographic and clinical characteristics of pts, nonaccess site bleeding was the independent predictor of 1-year mortality (OR 3.40, 95% CI 1.71 to 6.76; p<0.001), besides advanced age, heart failure and prior stroke. Access site bleeding was not the independent predictor of 1-year mortality after adjustment. Unadjusted 1-year mortality rates Conclusion: Pts with nonaccess site bleeding complicating primary PCI are at more than 3-fold higher risk of 1-year death compared with pts with access site bleeding and those that no bleed or does not require intervention.