The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk

Abstract

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.

Keywords: Acute Coronary Syndrome; Hemorrhage; Radial Artery.

Fig. 1

Flow chart of this study. TRI, trans-radial intervention; PCI, percutaneous coronary intervention; NSTE-ACS, non ST elevation acute coronary syndrome; UAP, unstable angina pectoris; CRUSADE, Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines; TFI, trans-femoral intervention.

Fig. 2

Incidences of in-hospital major bleeding according to the CRUSADE risk groups. MB, major bleeding.

Fig. 3

In-hospital and 1-yr clinical outcomes in patients with and without in-hospital major bleeding. TLR, target lesion revascularization; ST, stent thrombosis; CVA, cerebrovascular accident; MACCE, major adverse cerebro-cardiovascular events.

Fig. 4

Kaplan-Meier survival curves for 1-yr mortality according to occurrence of in-hospital major bleeding. IHMB, in-hospital major bleeding.

Fig. 5

Subgroup analyses for in-hospital major bleeding according to vascular access. OR, odds ratio; CI, confidence interval.