Bleeding complications in primary percutaneous coronary intervention of ST-elevation myocardial infarction in a radial center

Olivier Barthélémy, Johanne Silvain, David Brieger, Anne Mercadier, Remi Lancar, Anne Bellemain-Appaix, Farzin Beygui, Jean Philippe Collet, Dominique Costagliola, Gilles Montalescot
Catheterization and Cardiovascular Interventions 2012 January 1, 79 (1): 104-12

OBJECTIVES: We evaluated the incidence, types, and prognostic impact of bleeding complications in a non-selected patient population with ongoing STEMI treated with aggressive antithrombotic treatment and routine radial primary PCI.

BACKGROUND: Bleeding complications remain frequent and deleterious in primary PCI through femoral approach.

METHODS: STEMI patients (n = 671) were evaluated for bleeding complications using a web-based registry (e-PARIS). In-hospital bleeding was adjudicated using the TIMI definition.

RESULTS: In this non-selected, high risk population, 6.1% had cardiogenic shock on admission, 3.9% out-of-hospital cardiac arrest. Radial access (88%) was the default strategy as was abciximab (78%). Clopidogrel loading dose ranged from 300 to 900 mg. Pre-hospital fibrinolysis was rare (7.1%). Hemodynamic support devices (IABP, ECMO, Tandem Heart) were needed in 7.0%. In-hospital TIMI Major and TIMI Major/minor bleedings occurred in 2.5 and 5.7% of the population, respectively. In-hospital and 1-year mortality rates were 5.5 and 8.2%, respectively. Patients with in-hospital TIMI Major/minor bleeding had a higher 1-year mortality rate (31.6% vs. 3.8%, P < 0.001). The most frequent bleeding site was gastro-intestinal. Radial access was a strong predictor of survival (OR 0.33; 95%CI 0.17-0.56; P = 0.002).

CONCLUSIONS: In the setting of radial primary PCI, the rates and types of bleeding complications are somewhat different from those observed with femoral primary PCI. The gastro-intestinal tract has become the most frequent site of bleeding after radial primary PCI. The use of radial access appears independently associated with survival.

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