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Mamas M - AIMRADIAL 2015 - Access vs. non-access site bleeding


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Access versus non-access site bleeding and risk of subsequent mortality and major adverse cardiovascular events (MACE)

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Mamas M - AIMRADIAL 2015 - Access vs. non-access site bleeding

  1. 1. Access vs non-access site bleeding and risk of subsequent mortality and MACE Mamas Mamas Professor of Cardiology Keele University
  2. 2. • Previous literature reported conflicting data about both the incidence of access and non–access site-related bleeding complications and their relative prognostic impacts • Both incidence and prognostic impact will be determined by definition of major bleeding, severity of bleeding event, cohort studied, pharmacology used and way the bleed treated. • No previous systematic review or meta-analysis published studying the prevalence or prognostic impact of site-specific bleeding complications after PCI. Background
  3. 3. Incidence: Depends on definition Bleeding definitions composed of: • Clinical events: intracranial haemorrhagic, retroperitoneal bleed, haematomas etc • Change in laboratory parameters such as differing values of Hb drops, HCT changes • A clinical outcome such as death, receipt of blood transfusion Different definitions are composed of different combinations of above
  4. 4. Meta-analysis of 38 relevant studies including 520,401 patients 3.3 fold independent increased risk of mortality following major bleed
  5. 5. Prognostic impact depends on definition
  6. 6. Aim • The aim of the study is to provide an overview of site specific bleeding events and study their prognostic impact on mortality and MACE
  7. 7. Methods • Studies selected that investigated the impact of site-specific bleeding on mortality or MACE in patients who underwent PCI • A search of Embase (1974-March 2014) and Medline (1946- March 2014) on Ovid using search terms:
  8. 8. Study flow diagram 2,400,645 subjects with 106,490 bleeding events (4.5%)
  9. 9. Studies included
  10. 10. Access vs non-access site bleeding • 7 studies evaluated outcomes with access-site related bleeding complications (33,677 bleeding events in 301,404 patients; prevalence 11.2%) • 6 studies evaluated non-access site bleeding (29,600 bleeding events in 290,456 patients; prevalence 10.2%) • Crude mortality rates: – Access site bleeding: (2.8%) – Non-access site bleeding: (8.3%) – Patients without bleeding complications (1.9%)
  11. 11. Risk of mortality in access vs non-access bleeding complications
  12. 12. Sensitivity analyses • Similar findings in sensitivity analyses: – RCTs only – Studies that adjusted for anti-coagulant use – Studies that adjusted for ACS vs non ACS
  13. 13. Mechanism: Related to severity of bleed ? • Analysis of 3,694 patients who sustained bleeding event (4900 bleeding events) in SYNERGY Trial (9978pts) Vavalle et al. JACC Intv 2013
  14. 14. Mechanism? : Treatment of bleed
  15. 15. Impact of site-specific bleeds
  16. 16. Conclusions • Access site related bleeding complications have a similar incidence to those derived from non-access site sources • The prognostic impact of major bleeding complications depend on anatomical source • Both access and non-access site bleeding complications associated with adverse outcomes • Non-access site have a greater prognostic impact • Bleeding avoidance strategies such as access site choice and pharmacology should be considered as important parts of the PCI procedure.