The purpose of our study was to evaluate the use of bleeding-avoidance strategies
(BAS) and risk-adjusted bleeding over time in patients ≥80 years of age undergoing
primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial
infarction. We analyzed data from the CathPCI Registry from July 1, 2006 through June
30, 2009. Patients were included if they were ≥80 years old, presented with ST-segment
elevation myocardial infarction, and underwent primary PCI. We evaluated trends in
use of BAS (direct thrombin inhibitors, vascular closure devices, and radial access)
and risk-adjusted bleeding over time. Of 10,469 patients ≥80 years old undergoing
primary PCI, 1,002, (9.6%) developed a bleeding complication. Use of direct thrombin
inhibitors and vascular closure devices increased over time (12.8% to 24.9% and 29.2%
to 32.7%, p <0.01 and <0.05 for trends, respectively). Radial access was extremely
uncommon (<1%) and did not change over the course of the study. In multivariable analyses,
use of BAS was associated with lower bleeding. However, over the course of the study
period, overall risk-adjusted bleeding did not decrease significantly (9.9% to 9.4%,
p = 0.14 for trend). In conclusion, patients ≥80 years old undergoing primary PCI
are at high risk of bleeding, and despite significant increases in use of BAS, the
overall rate of bleeding complications remains high.
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Article Info
Publication History
Published online: April 05, 2012
Accepted:
February 17,
2012
Received in revised form:
February 17,
2012
Received:
December 14,
2011
Footnotes
The project described was supported by Award U01HL105270 from the National Heart, Lung, and Blood Institute , Bethesda, Maryland. Dr. Dodson is supported by Training Grant T32 AG019134 in Geriatric Clinical Epidemiology from the National Institutes of Health/National Institute on Aging , Bethesda, Maryland. Dr. Chaudhry is supported by Beeson Career Development Award K23 AG030986 from the National Institutes of Health/National Institute on Aging , Bethesda, Maryland. The CathPCI Registry is an initiative of the American College of Cardiology Foundation and the Society for Cardiovascular Angiography and Interventions.
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© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
