Influence of access, anticoagulant, and bleeding definition on outcomes of primary percutaneous coronary intervention

Early experience of an us academic center

M. K. Bheemarasetti, S. Shawar, S. Chithri, Wissam Khalife, Umamahesh Rangasetty, Kenichi Fujise, Syed Gilani

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1 Citation (Scopus)

Abstract

Background We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22% in radial/bivalirudin vs. 5% in radial/heparin vs. 17% in femoral/bivalirudin vs. 28% in femoral/heparin group; p = 0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p < 0.0001). The overall rate of major bleeding was 11.5%. When we use HORIZON-AMI bleeding definition, it went up to 25 % due to one particular component (p < 0.004). Conclusions This single center observational study doing PPCI did not show any superiority of one bleeding avoidance strategy over others with regard to primary outcome and its individual components except the hospital length of stay. It also shows the importance of bleeding definition on bleeding outcomes.

Original languageEnglish (US)
Pages (from-to)11-17
Number of pages7
JournalInternational Journal of Angiology
Volume24
Issue number1
DOIs
StatePublished - Feb 17 2014

Fingerprint

Percutaneous Coronary Intervention
Anticoagulants
Hemorrhage
Length of Stay
Thigh
Heparin
Stents
Observational Studies
Registries
Cause of Death
Thrombosis
Arteries

Keywords

  • bivalirudin
  • bleeding definition
  • radial access

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{539124d9e9cf4d8a82857dad81e9f5b2,
title = "Influence of access, anticoagulant, and bleeding definition on outcomes of primary percutaneous coronary intervention: Early experience of an us academic center",
abstract = "Background We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22{\%} in radial/bivalirudin vs. 5{\%} in radial/heparin vs. 17{\%} in femoral/bivalirudin vs. 28{\%} in femoral/heparin group; p = 0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p < 0.0001). The overall rate of major bleeding was 11.5{\%}. When we use HORIZON-AMI bleeding definition, it went up to 25 {\%} due to one particular component (p < 0.004). Conclusions This single center observational study doing PPCI did not show any superiority of one bleeding avoidance strategy over others with regard to primary outcome and its individual components except the hospital length of stay. It also shows the importance of bleeding definition on bleeding outcomes.",
keywords = "bivalirudin, bleeding definition, radial access",
author = "Bheemarasetti, {M. K.} and S. Shawar and S. Chithri and Wissam Khalife and Umamahesh Rangasetty and Kenichi Fujise and Syed Gilani",
year = "2014",
month = "2",
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language = "English (US)",
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TY - JOUR

T1 - Influence of access, anticoagulant, and bleeding definition on outcomes of primary percutaneous coronary intervention

T2 - Early experience of an us academic center

AU - Bheemarasetti, M. K.

AU - Shawar, S.

AU - Chithri, S.

AU - Khalife, Wissam

AU - Rangasetty, Umamahesh

AU - Fujise, Kenichi

AU - Gilani, Syed

PY - 2014/2/17

Y1 - 2014/2/17

N2 - Background We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22% in radial/bivalirudin vs. 5% in radial/heparin vs. 17% in femoral/bivalirudin vs. 28% in femoral/heparin group; p = 0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p < 0.0001). The overall rate of major bleeding was 11.5%. When we use HORIZON-AMI bleeding definition, it went up to 25 % due to one particular component (p < 0.004). Conclusions This single center observational study doing PPCI did not show any superiority of one bleeding avoidance strategy over others with regard to primary outcome and its individual components except the hospital length of stay. It also shows the importance of bleeding definition on bleeding outcomes.

AB - Background We aimed to carry out comparison of different bleeding avoidance strategies in doing primary percutaneous coronary intervention (PPCI) using either radial or femoral as access of choice and either bivalirudin or unfractionated heparin as anticoagulant of choice. In this analysis, we analyzed the influence of major bleeding definition on bleeding outcomes as well. Methods We did a retrospective analysis of 139 patients with ST-segment elevation myocardial infarction (STEMI) who had PPCI in our academic center from January 2010 till October 2013. The primary outcome at 30 days was a composite of death from any cause or stent thrombosis or non-coronary artery bypass grafting (CABG) related major bleeding (CathPCI Registry definition) and secondary outcomes were individual components of primary outcome and the hospital length of stay. Results There was no significant difference among different access/anticoagulant combinations with regards to primary outcome (22% in radial/bivalirudin vs. 5% in radial/heparin vs. 17% in femoral/bivalirudin vs. 28% in femoral/heparin group; p = 0.2) as well as its individual components except the hospital length of stay (2.56 vs. 3 vs. 3.97 vs. 4.4 days each; p < 0.0001). The overall rate of major bleeding was 11.5%. When we use HORIZON-AMI bleeding definition, it went up to 25 % due to one particular component (p < 0.004). Conclusions This single center observational study doing PPCI did not show any superiority of one bleeding avoidance strategy over others with regard to primary outcome and its individual components except the hospital length of stay. It also shows the importance of bleeding definition on bleeding outcomes.

KW - bivalirudin

KW - bleeding definition

KW - radial access

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U2 - 10.1055/s-0034-1394158

DO - 10.1055/s-0034-1394158

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JO - International Journal of Angiology

JF - International Journal of Angiology

SN - 1061-1711

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