Incidence and predictors of bleeding complications after percutaneous coronary intervention

Yohei Numasawa, Shun Kosaka, Ikuko Ueda, Hiroaki Miyata, Mitsuaki Sawano, Akio Kawamura, Shigetaka Noma, Masahiro Suzuki, Susumu Nakagawa, Yukihiko Momiyama, Keiichi Fukuda

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. Methods: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). Results: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. Conclusions: The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - 2016 Jan 5

Fingerprint

Percutaneous Coronary Intervention
Hemorrhage
Incidence
Registries
Area Under Curve
Japan
Intra-Aortic Balloon Pumping
Cardiogenic Shock
Terminology
Anticoagulants
Renal Dialysis
Heart Failure
Logistic Models
Regression Analysis
Databases

Keywords

  • Bleeding
  • Coronary artery disease
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Incidence and predictors of bleeding complications after percutaneous coronary intervention. / Numasawa, Yohei; Kosaka, Shun; Ueda, Ikuko; Miyata, Hiroaki; Sawano, Mitsuaki; Kawamura, Akio; Noma, Shigetaka; Suzuki, Masahiro; Nakagawa, Susumu; Momiyama, Yukihiko; Fukuda, Keiichi.

In: Journal of Cardiology, 05.01.2016.

Research output: Contribution to journalArticle

Numasawa, Yohei ; Kosaka, Shun ; Ueda, Ikuko ; Miyata, Hiroaki ; Sawano, Mitsuaki ; Kawamura, Akio ; Noma, Shigetaka ; Suzuki, Masahiro ; Nakagawa, Susumu ; Momiyama, Yukihiko ; Fukuda, Keiichi. / Incidence and predictors of bleeding complications after percutaneous coronary intervention. In: Journal of Cardiology. 2016.
@article{437ca79a824344cf969063435a5c28d3,
title = "Incidence and predictors of bleeding complications after percutaneous coronary intervention",
abstract = "Background: Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. Methods: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). Results: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1{\%}). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. Conclusions: The incidence of bleeding complications among Japanese PCI patients was approximately 3{\%} in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.",
keywords = "Bleeding, Coronary artery disease, Percutaneous coronary intervention",
author = "Yohei Numasawa and Shun Kosaka and Ikuko Ueda and Hiroaki Miyata and Mitsuaki Sawano and Akio Kawamura and Shigetaka Noma and Masahiro Suzuki and Susumu Nakagawa and Yukihiko Momiyama and Keiichi Fukuda",
year = "2016",
month = "1",
day = "5",
doi = "10.1016/j.jjcc.2016.05.003",
language = "English",
journal = "Journal of cardiography. Supplement",
issn = "0914-5087",
publisher = "Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)",

}

TY - JOUR

T1 - Incidence and predictors of bleeding complications after percutaneous coronary intervention

AU - Numasawa, Yohei

AU - Kosaka, Shun

AU - Ueda, Ikuko

AU - Miyata, Hiroaki

AU - Sawano, Mitsuaki

AU - Kawamura, Akio

AU - Noma, Shigetaka

AU - Suzuki, Masahiro

AU - Nakagawa, Susumu

AU - Momiyama, Yukihiko

AU - Fukuda, Keiichi

PY - 2016/1/5

Y1 - 2016/1/5

N2 - Background: Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. Methods: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). Results: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. Conclusions: The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.

AB - Background: Bleeding complications remain one of the most important challenges in percutaneous coronary intervention (PCI), particularly in Asians who are known to be vulnerable to the use of antiplatelets or anticoagulants. However, the incidence and predictors of bleeding complications after PCI have not been thoroughly investigated in Japan. Methods: We studied 13,075 consecutive patients in a Japanese multicenter PCI registry (Japan Cardiovascular Database - Keio interhospital Cardiovascular Study: JCD-KiCS) from September 2008 to March 2014. Multivariate logistic regression analysis was performed to investigate independent predictors of bleeding complications, and to create three risk prediction models for bleeding events. Model 1 included patients' characteristics alone. In model 2, we added patients' clinical presentation. Model 3 included covariates in model 2 along with angiographic and technical factors. Model discrimination was assessed using the area under the receiver operating curve (AUC). Results: Overall, bleeding complications, according to the pre-specified US National Cardiovascular Data Registry criteria, were observed in 402 patients (3.1%). Independent predictors of bleeding complications included age, female gender, previous PCI, previous heart failure, hemodialysis (variables included in model 1), ST-elevation and non-ST-elevation myocardial infarction, cardiogenic shock (added in model 2), transradial intervention, use of intra-aortic balloon pumping or a rotablator, and PCI for chronic total occlusion (added in model 3). Above all, previous PCI and transradial intervention were inverse predictors of bleeding. The predictability of the risk models improved as the number of variables increased, with AUC of 0.667, 0.747, and 0.791 for models 1, 2, and 3, respectively. Conclusions: The incidence of bleeding complications among Japanese PCI patients was approximately 3% in standard nomenclature, which is equivalent to that of other international registries. Patients' characteristics, clinical presentation, and angiographic and technical factors all independently contributed to its prediction.

KW - Bleeding

KW - Coronary artery disease

KW - Percutaneous coronary intervention

UR - http://www.scopus.com/inward/record.url?scp=84971597448&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84971597448&partnerID=8YFLogxK

U2 - 10.1016/j.jjcc.2016.05.003

DO - 10.1016/j.jjcc.2016.05.003

M3 - Article

JO - Journal of cardiography. Supplement

JF - Journal of cardiography. Supplement

SN - 0914-5087

ER -