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Changes in periprocedural bleeding complications following percutaneous coronary intervention in The United Kingdom between 2006 and 2013 (from the British Cardiovascular Interventional Society)

Changes in periprocedural bleeding complications following percutaneous coronary intervention in The United Kingdom between 2006 and 2013 (from the British Cardiovascular Interventional Society)
Changes in periprocedural bleeding complications following percutaneous coronary intervention in The United Kingdom between 2006 and 2013 (from the British Cardiovascular Interventional Society)

Major bleeding is a common complication after percutaneous coronary intervention (PCI), although little is known about how bleeding rates have changed over time and what has driven this. We analyzed all patients who underwent PCI in England and Wales from 2006 to 2013. Multivariate analyses using logistic regression models were performed to identify predictors of bleeding to identify potential factors influencing bleeding trends over time. 545,604 participants who had PCI in England and Wales between 2006 and 2013 were included in the analyses. Overall bleeding rates decreased from 7.0 (CI 6.2 to 7.8) per 1,000 procedures in 2006 to 5.5 (CI 4.7 to 6.2) per 1,000 in 2013. Increasing age, female sex, GPIIb/IIIa inhibitors use, and circulatory support were independently associated with increased risk of bleeding complications whereas radial access and vascular closure device use were independently associated with decreases in risk. Decreases in bleeding rates over time were associated with radial access site, and changes in pharmacology, but this was offset by greater proportion of ACS cases and the adverse patient clinical demographics. In conclusion, major bleeding complications after PCI have decreased due to changes in access site practice and decreased usage of GPIIb/IIIa inhibitors, but this is offset by the increase of patients with higher propensity to bleed. Changes in access site practice nationally have the potential to significantly reduce major bleeding after PCI.

0002-9149
Olier, Ivan
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Carr, Matthew
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Curzen, Nick
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Ludman, Peter
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Baumbach, Andreas
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Kinnaird, Tim
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de Belder, Mark A.
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Hildick-Smith, Dave
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Sirker, Alex
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Kwok, Chun Shing
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Rashid, Muhammad
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Nolan, Jim
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Kontopantelis, Evangelos
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Mamas, Mamas A.
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Olier, Ivan
c2f14930-6e95-4889-bb02-70e5a5b570d7
Carr, Matthew
ecfdf631-8089-4f57-9a44-6bc40f412314
Curzen, Nick
70f3ea49-51b1-418f-8e56-8210aef1abf4
Ludman, Peter
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Baumbach, Andreas
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Kinnaird, Tim
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de Belder, Mark A.
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Hildick-Smith, Dave
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Sirker, Alex
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Kwok, Chun Shing
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Rashid, Muhammad
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Nolan, Jim
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Kontopantelis, Evangelos
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Mamas, Mamas A.
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Olier, Ivan, Carr, Matthew, Curzen, Nick, Ludman, Peter, Baumbach, Andreas, Kinnaird, Tim, de Belder, Mark A., Hildick-Smith, Dave, Sirker, Alex, Kwok, Chun Shing, Rashid, Muhammad, Nolan, Jim, Kontopantelis, Evangelos and Mamas, Mamas A. (2018) Changes in periprocedural bleeding complications following percutaneous coronary intervention in The United Kingdom between 2006 and 2013 (from the British Cardiovascular Interventional Society). American Journal of Cardiology. (doi:10.1016/j.amjcard.2018.06.016).

Record type: Article

Abstract

Major bleeding is a common complication after percutaneous coronary intervention (PCI), although little is known about how bleeding rates have changed over time and what has driven this. We analyzed all patients who underwent PCI in England and Wales from 2006 to 2013. Multivariate analyses using logistic regression models were performed to identify predictors of bleeding to identify potential factors influencing bleeding trends over time. 545,604 participants who had PCI in England and Wales between 2006 and 2013 were included in the analyses. Overall bleeding rates decreased from 7.0 (CI 6.2 to 7.8) per 1,000 procedures in 2006 to 5.5 (CI 4.7 to 6.2) per 1,000 in 2013. Increasing age, female sex, GPIIb/IIIa inhibitors use, and circulatory support were independently associated with increased risk of bleeding complications whereas radial access and vascular closure device use were independently associated with decreases in risk. Decreases in bleeding rates over time were associated with radial access site, and changes in pharmacology, but this was offset by greater proportion of ACS cases and the adverse patient clinical demographics. In conclusion, major bleeding complications after PCI have decreased due to changes in access site practice and decreased usage of GPIIb/IIIa inhibitors, but this is offset by the increase of patients with higher propensity to bleed. Changes in access site practice nationally have the potential to significantly reduce major bleeding after PCI.

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More information

Accepted/In Press date: 1 June 2018
e-pub ahead of print date: 8 July 2018

Identifiers

Local EPrints ID: 424479
URI: http://eprints.soton.ac.uk/id/eprint/424479
ISSN: 0002-9149
PURE UUID: 00f6cd49-c9a2-418a-95e4-c6435c497411
ORCID for Nick Curzen: ORCID iD orcid.org/0000-0001-9651-7829

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Date deposited: 05 Oct 2018 11:37
Last modified: 18 Feb 2021 17:04

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Contributors

Author: Ivan Olier
Author: Matthew Carr
Author: Nick Curzen ORCID iD
Author: Peter Ludman
Author: Andreas Baumbach
Author: Tim Kinnaird
Author: Mark A. de Belder
Author: Dave Hildick-Smith
Author: Alex Sirker
Author: Chun Shing Kwok
Author: Muhammad Rashid
Author: Jim Nolan
Author: Evangelos Kontopantelis
Author: Mamas A. Mamas

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