Major bleeding after PCI. Where is our crystal ball?

Abstract

Over the last three decades, there have been remarkable advances in percutaneous coronary intervention (PCI). Utilization of coronary stents and combination antiplatelet/antithrombotic therapy have led to significant improvements in revascularization success rates as well as marked reductions in thrombotic complications. Patients considering elective procedures are now routinely quoted a 800 000 PCI procedures are performed annually in Europe.1 In addition, PCI is being performed in increasingly complex patients, including the elderly and those with multiple co-morbidities, who are at higher risk for incurring procedural complications. However, with increased utilization of PCI, increased use of combinations of multiple antithrombotic agents, and the reduction in the occurrence of ischaemic/thrombotic complications of PCI, there has emerged recognition that post-procedural bleeding complications remain all too common and result in significant morbidity and mortality. In a retrospective analysis of >10 000 patients undergoing PCI at a single centre between 1991 and 2000, major bleeding occurred in 5.4% of patients and was associated with a 3.5-fold increased adjusted risk of in-hospital mortality.2 Similarly, in an analysis of >24 000 patients with acute coronary syndromes enrolled in the Global Registry of Acute Coronary Events (GRACE), major bleeding occurred in 5.5% of patients undergoing PCI and was associated with a significant increase in hospital death.3 Finally, it has been estimated that the incremental cost of prolonged hospitalization and treatment associated with bleeding complications exceeds US$10 000/hospital stay. … *Corresponding author. Tel: +33 1 40 25 86 68. E-mail address : gabriel.steg{at}bch.aphp.fr