Author + information
- Received January 15, 2019
- Revision received March 8, 2019
- Accepted March 12, 2019
- Published online June 17, 2019.
- Bhaskar Bhardwaj, MDa,b,
- John A. Spertus, MD, MPHb,c,
- Kevin F. Kennedy, MSc,
- W. Schuyler Jones, MDd,
- David Safley, MDc,
- Thomas T. Tsai, MD, MSce,
- Herbert D. Aronow, MD, MPHf,
- Amit N. Vora, MD, MPHd,
- Yashashwi Pokharel, MD, MSCRb,c,
- Arun Kumar, MDa,
- Robert R. Attaran, MBBSg,
- Dmitriy N. Feldman, MDh,
- Ehrin Armstrong, MDi,
- Anand Prasad, MDj,
- Bruce Gray, DOk and
- Adam C. Salisbury, MD, MScb,c,∗ ()
- aDivision of Cardiovascular Diseases, University of Missouri, Columbia, Missouri
- bDepartment of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri
- cDivision of Cardiovascular Medicine, Saint Luke’s Mid-America Heart Institute, Kansas City, Missouri
- dDivision of Cardiology, Duke University Health System, Duke Heart Center, Durham, North Carolina
- eDivision of Cardiovascular Medicine, University of Colorado and Institute for Health Research, Kaiser Permanente, Denver, Colorado
- fDivision of Cardiovascular Medicine, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island
- gDepartment of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
- hDivision of Cardiology, Weill Cornell Medical College, New York, New York
- iDivision of Cardiovascular Medicine, University of Colorado, Denver, Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
- jDivision of Cardiology, Department of Medicine, UT Health San Antonio, San Antonio, Texas
- kDepartment of Surgery at Greenville Health System, Greenville, South Carolina
- ↵∗Address for correspondence:
Dr. Adam C. Salisbury, 4401 Wornall Road, CV Research 9th Floor, Kansas City, Missouri 64111.
Objectives This study sought to assess periprocedural bleeding complications in lower-extremity peripheral vascular interventions (PVIs).
Background Few studies have examined the incidence, predictors, or outcomes of periprocedural bleeding after lower-extremity PVI.
Methods The study examined patients undergoing PVI at 76 hospitals in the National Cardiovascular Data Registry PVI registry from 2014 to 2016. Post-PVI major bleeding was defined as any overt bleeding with a hemoglobin (Hb) drop of ≥3 g/dl, any Hb decline of ≥4 g/dl, or blood transfusion in patients with pre-procedure Hb >8 g/dl within 72 h of their procedure. Hierarchical multivariable logistic regression was used to identify factors independently associated with post-PVI bleeding. The study also examined adjusted in-hospital mortality among patients with or without major bleeding complications.
Results Among 18,289 PVI procedures, major bleeding occurred in 744 (4.10%). Patient characteristics independently associated with bleeding included age, female sex, heart failure, pre-procedural hemoglobin <12 g/dl, nonelective PVI, and critical limb ischemia on presentation. Procedural characteristics associated with bleeding included nonfemoral vascular access, use of thrombolytic therapy, PVI of the aortoiliac segment, and multilesion interventions, whereas use of closure devices was associated with less bleeding. All-cause in-hospital mortality was higher in patients who experienced bleeding than in those who did not (6.60% vs. 0.30%; p < 0.001; adjusted hazard ratio: 10.9; 95% confidence interval: 6.9 to 17.0).
Conclusions Major bleeding occurred in 4.10% of lower-extremity PVI procedures and was associated with several patient and procedural characteristics, as well as in-hospital mortality. These insights can be incorporated into strategies to reduce periprocedural bleeding after PVI.
Dr. Pokharel has received funding support from the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number T32HL110837. Dr. Spertus has a research contract from the American College of Cardiology to analyze the National Cardiovascular Data Registry; has served as a consultant for Janssen, Bayer, Novartis, and AstraZeneca; owns equity in Health Outcomes Sciences and copyright to the Peripheral Artery Questionnaire; and has served on the board for Blue Cross Blue Shield of Kansas City. Dr. Jones has received research grant support from the Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Bristol-Myers Squibb, Doris Duke Charitable Foundation, Merck, and Patient-Centered Outcomes Research Institute; and received honoraria/other from the American College of Physicians, Bayer, Bristol-Myers Squibb, Daiichi Sankyo, and Janssen Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 15, 2019.
- Revision received March 8, 2019.
- Accepted March 12, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.