Author + information
- Received November 19, 2013
- Accepted January 4, 2014
- Published online June 1, 2014.
- Wouter J. Kikkert, MD∗,
- Ronak Delewi, MD∗,
- Dagmar M. Ouweneel, MSc∗,
- Sophie H. van Nes∗,
- Marije M. Vis, MD, PhD∗,
- Jan Baan Jr., MD, PhD∗,
- Karel T. Koch, MD, PhD∗,
- George D. Dangas, MD, PhD†,‡,
- Roxana Mehran, MD†,‡,
- Robbert J. de Winter, MD, PhD∗,
- Ron J.G. Peters, MD, PhD∗,
- Jan J. Piek, MD, PhD∗,
- Jan G.P. Tijssen, PhD∗ and
- Jose P.S. Henriques, MD, PhD∗∗ ()
- ∗Academic Medical Center–University of Amsterdam, Amsterdam, the Netherlands
- †Cardiovascular Research Foundation, New York, New York
- ‡Mount Sinai Medical Center, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Jose P. S. Henriques, Department of Cardiology, B2-115, Academic Medical Center–University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands.
Objectives This study sought to investigate the prognostic value of access site bleeding (ASB) and non-ASB for recurrent ischemic outcomes and mortality in patients with ST-segment elevation myocardial infarction (STEMI).
Background The prognostic value of ASB-related complications after STEMI is subject to debate.
Methods The prognostic value of ASB and non-ASB for 1-year mortality, recurrent myocardial infarction (MI), stent thrombosis, and stroke was investigated in 2,002 STEMI patients undergoing primary percutaneous coronary intervention. In addition, we performed a meta-analysis of studies investigating the prognostic value of ASB and non-ASB in patients undergoing percutaneous coronary intervention.
Results Seventy-four patients (3.7%) were treated by radial access. ASB developed in 124 patients (6.3%) and non-ASB developed in 102 (5.2%). By multivariable analysis, ASB was not associated with a higher risk of 1-year mortality (hazard ratio [HR]: 1.03; p = 0.89), recurrent MI (HR: 1.16; p = 0.64), stent thrombosis (HR: 0.55; p = 0.42), or stroke (HR: 0.47; p = 0.31). Non-ASB was independently associated with 1-year mortality (HR: 2.77; p < 0.001) and stent thrombosis (HR: 3.10; p = 0.021), but not with recurrent MI and stroke. In a meta-analysis including 495,630 patients, non-ASB was associated with a greater adjusted risk of subsequent 1-year mortality than ASB (HR: 1.66; 95% CI: 1.56 to 1.76 and HR: 1.21; 95% CI: 1.11 to 1.31).
Conclusions In STEMI, ASB was not significantly associated with 1-year clinical outcomes, whereas non-ASB was significantly associated with 1-year mortality and stent thrombosis. These results taken together with those of previous studies indicate a greater risk of subsequent mortality in patients with non-ASB.
- major bleeding
- percutaneous coronary intervention
- primary percutaneous coronary intervention
- ST-segment elevation myocardial infarction
- vascular access site
This work was supported by The Nuts OHRA Foundation, the Netherlands (SNO-T-0702-61). Dr. Mehran has received institutional research grant support from The Medicines Company, Bristol-Myers Squibb, Sanofi-Aventis, and Eli Lilly/Daiichi Sankyo; is a consultant for Abbott Vascular, AstraZeneca, Boston Scientific, Covidien, CSL Behring, Janssen Pharmaceuticals, Maya Medical, Merck & Co., Regado Biosciences, and Sanofi-Aventis; is on the advisory board of Covidien, Janssen Pharmaceuticals, and Sanofi-Aventis; and has equity and is a shareholder in Endothelix, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 19, 2013.
- Accepted January 4, 2014.
- American College of Cardiology Foundation