Author + information
- Christopher Huffman,
- Rebecca Torguson,
- Fang Chen,
- Augusto Pichard,
- Lowell Satler,
- Kenneth Kent,
- William Suddath and
- Ron Waksman
Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the age of transcatheter aortic valve replacement (TAVR), patients with AS frequently undergo PCI prior to TAVR; therefore, understanding whether these patients have a higher risk of bleeding is critical.
This retrospective study included 7,926 patients who underwent PCI from March 18, 2004 to January 31, 2013. Patients were categorized according to the presence of hemodynamically significant AS: Moderate/Severe AS (n=354) and Mild/No AS (n=7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (requiring transfusion, prolonged hospital stay, or drop in hemoglobin >3.0 mg/dL) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score (risk score components in Table) was used to control for the underlying bleeding risk due to baseline patient characteristics.
Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes in these patients. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores as well as higher rates of bleeding events (Table). There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using Net Reclassification Improvement did not enhance the model's ability to predict bleeding (p=0.71).
These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with moderate or severe AS. As more patients with increasingly severe comorbidities undergo TAVR evaluation, with some requiring PCI, this risk score may need further adjustment to account for the increasingly complex and frail nature of the TAVR population.
|Moderate/Severe AS||Mild/No AS||p Value|
|Age, years||79.9 10.98||65.06 12.23||< 0.001|
|Female Gender, %||45.5||35.9||< 0.001|
|Congestive Heart Failure, %||37.9||16.7||< 0.001|
|Congestive Heart Failure Class III or IV, %||20.7||8.4||< 0.001|
|History of PCI, %||27.5||30.6||0.212|
|History of Peripheral Vascular Disease, %||27.9||16.1||< 0.001|
|Chronic Renal Insufficiency, %||37.7||18.0||< 0.001|
|Myocardial Infarction This Admission, %||27.8||38.1||< 0.001|
|Cardiogenic Shock, %||2.1||3.5||0.158|
|NCDR PCI Bleeding Score||18.71 7.55||12.97 7.56||< 0.001|
|Hematocrit Drop > 15, %||4.1||2.1||0.011|
|Hematoma, %||5.8||2.2||< 0.001|
|NCDR Bleeding Event, %||10.3||4.9||< 0.001|