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. 2014 Feb 13;1(1):e000021.
doi: 10.1136/openhrt-2013-000021. eCollection 2014.

Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis

Chun Shing Kwok  1 , Sunil V Rao  2 , Phyo K Myint  3 , Bernard Keavney  1 , James Nolan  4 , Peter F Ludman  5 , Mark A de Belder  6 , Yoon K Loke  7 , Mamas A Mamas  1
Affiliations

Major bleeding after percutaneous coronary intervention and risk of subsequent mortality: a systematic review and meta-analysis

Chun Shing Kwok et al. Open Heart. .

Abstract

Objectives: To examine the relationship between periprocedural bleeding complications and major adverse cardiovascular events (MACEs) and mortality outcomes following percutaneous coronary intervention (PCI) and study differences in the prognostic impact of different bleeding definitions.

Methods: We conducted a systematic review and meta-analysis of PCI studies that evaluated periprocedural bleeding complications and their impact on MACEs and mortality outcomes. A systematic search of MEDLINE and EMBASE was conducted to identify relevant studies. Data from relevant studies were extracted and random effects meta-analysis was used to estimate the risk of adverse outcomes with periprocedural bleeding. Statistical heterogeneity was assessed by considering the I(2) statistic.

Results: 42 relevant studies were identified including 533 333 patients. Meta-analysis demonstrated that periprocedural major bleeding complications was independently associated with increased risk of mortality (OR 3.31 (2.86 to 3.82), I(2)=80%) and MACEs (OR 3.89 (3.26 to 4.64), I(2)=42%). A differential impact of major bleeding as defined by different bleeding definitions on mortality outcomes was observed, in which the REPLACE-2 (OR 6.69, 95% CI 2.26 to 19.81), STEEPLE (OR 6.59, 95% CI 3.89 to 11.16) and BARC (OR 5.40, 95% CI 1.74 to 16.74) had the worst prognostic impacts while HORIZONS-AMI (OR 1.51, 95% CI 1.11 to 2.05) had the least impact on mortality outcomes.

Conclusions: Major bleeding after PCI is independently associated with a threefold increase in mortality and MACEs outcomes. Different contemporary bleeding definitions have differential impacts on mortality outcomes, with 1.5-6.7-fold increases in mortality observed depending on the definition of major bleeding used.

Keywords: ALLIED SPECIALITIES; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD).

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Figures

Figure 1
Figure 1
Adjusted risk of mortality with and without major bleed after percutaneous coronary intervention.
Figure 2
Figure 2
Adjusted risk of major adverse cardiovascular event with and without major bleed after percutaneous coronary intervention.
Figure 3
Figure 3
Risk of mortality with major bleed with different duration of follow-up.
See this image and copyright information in PMC

Comment in

References

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