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Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease.
Clin Res Cardiol. 2014 Jan; 103(1):49-56.CR

Abstract

BACKGROUND

Limited information exists on the prognostic impact of bleeding after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD). We investigated the impact of bleeding after PCI on the outcome of these patients.

METHODS

The study included 2,934 patients with estimated creatinine clearance <60 ml/min. Bleeding events within 30 days after PCI were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1-year mortality.

RESULTS

Bleeding events occurred in 485 patients (16.5 %). BARC classes were: class 1 (n = 155), class 2 (n = 73), class 3a (n = 182), class 3b (n = 68), class 3c (n = 6) and class 4 (n = 1). There were 212 deaths over the first year after PCI: 60 deaths in patients who bled and 152 deaths in patients who did not bleed (Kaplan-Meier [KM] estimates, 12.5 and 6.3 %; odds ratio [OR] = 2.11, 95 % confidence interval [CI] 1.57-2.83, P < 0.001). Nonfatal myocardial infarction occurred in 71 patients who bled and in 141 patients who did not bleed (KM estimates, 14.8 and 5.8 %; OR = 2.70 [2.05-3.55], P < 0.001). After adjustment, bleeding was independently associated with increased risk of 1-year mortality (adjusted hazard ratio [HR] = 1.90 [1.33-2.72], P < 0.001) and myocardial infarction (adjusted HR = 2.74 [1.99-3.78], P < 0.001). Bleeding improved the discriminatory power of the multivariable model for prediction of mortality (absolute and relative integrated discrimination improvement [IDI], 0.011 and 15.4 %; P = 0.004) or myocardial infarction (absolute and relative IDI, 0.017 and 70.8 %; P < 0.001).

CONCLUSIONS

Peri-PCI bleeding in patients with CKD is independently associated with the increased risk of 1-year mortality and nonfatal myocardial infarction.

Authors+Show Affiliations

Deutsches Herzzentrum, Lazarettstrasse 36, 80636, Munich, Germany, ndrepepa@dhm.mhn.de.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24092474

Citation

Ndrepepa, Gjin, et al. "Incidence and Impact On Prognosis of Bleeding During Percutaneous Coronary Interventions in Patients With Chronic Kidney Disease." Clinical Research in Cardiology : Official Journal of the German Cardiac Society, vol. 103, no. 1, 2014, pp. 49-56.
Ndrepepa G, Neumann FJ, Cassese S, et al. Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease. Clin Res Cardiol. 2014;103(1):49-56.
Ndrepepa, G., Neumann, F. J., Cassese, S., Fusaro, M., Ott, I., Schulz, S., Hoppmann, P., Richardt, G., Laugwitz, K. L., Schunkert, H., & Kastrati, A. (2014). Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease. Clinical Research in Cardiology : Official Journal of the German Cardiac Society, 103(1), 49-56. https://doi.org/10.1007/s00392-013-0622-x
Ndrepepa G, et al. Incidence and Impact On Prognosis of Bleeding During Percutaneous Coronary Interventions in Patients With Chronic Kidney Disease. Clin Res Cardiol. 2014;103(1):49-56. PubMed PMID: 24092474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and impact on prognosis of bleeding during percutaneous coronary interventions in patients with chronic kidney disease. AU - Ndrepepa,Gjin, AU - Neumann,Franz-Josef, AU - Cassese,Salvatore, AU - Fusaro,Massimiliano, AU - Ott,Ilka, AU - Schulz,Stefanie, AU - Hoppmann,Petra, AU - Richardt,Gert, AU - Laugwitz,Karl-Ludwig, AU - Schunkert,Heribert, AU - Kastrati,Adnan, Y1 - 2013/10/04/ PY - 2013/07/24/received PY - 2013/09/18/accepted PY - 2013/10/5/entrez PY - 2013/10/5/pubmed PY - 2014/9/12/medline SP - 49 EP - 56 JF - Clinical research in cardiology : official journal of the German Cardiac Society JO - Clin Res Cardiol VL - 103 IS - 1 N2 - BACKGROUND: Limited information exists on the prognostic impact of bleeding after percutaneous coronary intervention (PCI) in patients with chronic kidney disease (CKD). We investigated the impact of bleeding after PCI on the outcome of these patients. METHODS: The study included 2,934 patients with estimated creatinine clearance <60 ml/min. Bleeding events within 30 days after PCI were assessed using the Bleeding Academic Research Consortium (BARC) criteria. The primary outcome was 1-year mortality. RESULTS: Bleeding events occurred in 485 patients (16.5 %). BARC classes were: class 1 (n = 155), class 2 (n = 73), class 3a (n = 182), class 3b (n = 68), class 3c (n = 6) and class 4 (n = 1). There were 212 deaths over the first year after PCI: 60 deaths in patients who bled and 152 deaths in patients who did not bleed (Kaplan-Meier [KM] estimates, 12.5 and 6.3 %; odds ratio [OR] = 2.11, 95 % confidence interval [CI] 1.57-2.83, P < 0.001). Nonfatal myocardial infarction occurred in 71 patients who bled and in 141 patients who did not bleed (KM estimates, 14.8 and 5.8 %; OR = 2.70 [2.05-3.55], P < 0.001). After adjustment, bleeding was independently associated with increased risk of 1-year mortality (adjusted hazard ratio [HR] = 1.90 [1.33-2.72], P < 0.001) and myocardial infarction (adjusted HR = 2.74 [1.99-3.78], P < 0.001). Bleeding improved the discriminatory power of the multivariable model for prediction of mortality (absolute and relative integrated discrimination improvement [IDI], 0.011 and 15.4 %; P = 0.004) or myocardial infarction (absolute and relative IDI, 0.017 and 70.8 %; P < 0.001). CONCLUSIONS: Peri-PCI bleeding in patients with CKD is independently associated with the increased risk of 1-year mortality and nonfatal myocardial infarction. SN - 1861-0692 UR - https://www.unboundmedicine.com/medline/citation/24092474/Incidence_and_impact_on_prognosis_of_bleeding_during_percutaneous_coronary_interventions_in_patients_with_chronic_kidney_disease_ L2 - https://dx.doi.org/10.1007/s00392-013-0622-x DB - PRIME DP - Unbound Medicine ER -