Original Investigation
Baseline Bleeding Risk and Arterial Access Site Practice in Relation to Procedural Outcomes After Percutaneous Coronary Intervention

https://doi.org/10.1016/j.jacc.2014.05.075Get rights and content
Under an Elsevier user license
open archive

Abstract

Background

Transradial access (TRA) has been associated with reduced access site–related bleeding complications and mortality after percutaneous coronary intervention (PCI). It is unclear, however, whether these observed benefits are influenced by baseline bleeding risk.

Objectives

This study investigated the relationship between baseline bleeding risk, TRA utilization, and procedure-related outcomes in patients undergoing PCI enrolled in the British Cardiovascular Intervention Society database.

Methods

Baseline bleeding risk was calculated by using modified Mehran bleeding risk scores in 348,689 PCI procedures performed between 2006 and 2011. Four categories for bleeding risk were defined for the modified Mehran risk score (MMRS): low (<10), moderate (10 to 14), high (15 to 19), and very high (≥20). The impact of baseline bleeding risk on 30-day mortality and its relationship with access site were studied.

Results

TRA was independently associated with a 35% reduction in 30-day mortality risk (odds ratio [OR]: 0.65 [95% confidence interval (CI): 0.59 to 0.72]; p < 0.0001), with the magnitude of mortality reduction related to baseline bleeding risk (MMRS <10, OR: 0.73 [95% CI: 0.62 to 0.86]; MMRS ≥20, OR: 0.53 [95% CI: 0.47 to 0.61]). In patients with an MMRS <10, TRA was used in 71,771 (43.2%) of 166,083 PCI procedures; TRA was used in 8,655 (40.1%) of 21,559 PCI procedures in patients with an MMRS ≥20, illustrating that TRA was used less in those at highest risk from bleeding complications (p < 0.0001).

Conclusions

TRA was independently associated with reduced 30-day mortality, and the magnitude of this effect was related to baseline bleeding risk; those at highest risk of bleeding complications gained the greatest benefit from adoption of TRA during PCI.

Key Words

access site
bleeding risk
femoral
Mehran risk score
outcomes
transfemoral
transradial
radial

Abbreviations and Acronyms

BCIS
British Cardiovascular Intervention Society
CABG
coronary artery bypass graft
CI
confidence interval
MI
myocardial infarction
NHS
National Health Service
NSTEMI
non–ST-segment elevation myocardial infarction
OR
odds ratio
PCI
percutaneous coronary intervention
STEMI
ST-elevation myocardial infarction
TFA
transfemoral access
TIMI
Thrombolysis In Myocardial Infarction
TRA
transradial access

Cited by (0)

Dr. de Belder has reported receiving a travel grant from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Mamas and Anderson contributed equally to this work.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

You can also listen to this issue's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.