Impact of Major Bleeding on Long-Term Mortality in Anemic Versus Nonanemic Patients Undergoing Percutaneous Coronary Intervention Using Bivalirudin
Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term morta...
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| Veröffentlicht in: | The American journal of cardiology 2014-05, Vol.113 (9), p.1481-1486 |
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| creator | Ali, Ziad A., MD, DPhil Poludasu, Shyam, MD Qureshi, Yasir H., MD Krishnan, Prakash, MD Ali, Ayyaz A., MD Tatonetti, Nicholas, PhD Downey, Peter, MD Zalewski, Adrian, BSc Nazif, Tamim, MD George, Isaac, MD Mandava, Anupa, MD Baber, Usman, MD Dangas, George, MD Mehran, Roxana, MD Kini, Annapoorna S., MD Sharma, Samin K., MD |
| description | Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p |
| doi_str_mv | 10.1016/j.amjcard.2014.01.427 |
| format | Article |
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Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.01.427</identifier><identifier>PMID: 24630790</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Acute coronary syndromes ; Age ; Aged ; Anemia ; Anemia, Hypochromic - complications ; Antithrombins - therapeutic use ; Body mass index ; Cardiovascular ; Diabetes ; Female ; Heart attacks ; Hemorrhage - complications ; Hirudins ; Humans ; Kidney diseases ; Male ; Mortality ; Normal distribution ; Peptide Fragments - therapeutic use ; Percutaneous Coronary Intervention - mortality ; Postoperative Complications - mortality ; Postoperative Complications - prevention & control ; Recombinant Proteins - therapeutic use ; Stents ; Studies ; Variables</subject><ispartof>The American journal of cardiology, 2014-05, Vol.113 (9), p.1481-1486</ispartof><rights>Elsevier Inc.</rights><rights>2014 Elsevier Inc.</rights><rights>Copyright © 2014 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited May 1, 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c514t-82b20aadbf486c7b36deda6e8afd6e6bb4e29ce2f2b48437c6b45ce372fb0b843</citedby><cites>FETCH-LOGICAL-c514t-82b20aadbf486c7b36deda6e8afd6e6bb4e29ce2f2b48437c6b45ce372fb0b843</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914914006262$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24630790$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ali, Ziad A., MD, DPhil</creatorcontrib><creatorcontrib>Poludasu, Shyam, MD</creatorcontrib><creatorcontrib>Qureshi, Yasir H., MD</creatorcontrib><creatorcontrib>Krishnan, Prakash, MD</creatorcontrib><creatorcontrib>Ali, Ayyaz A., MD</creatorcontrib><creatorcontrib>Tatonetti, Nicholas, PhD</creatorcontrib><creatorcontrib>Downey, Peter, MD</creatorcontrib><creatorcontrib>Zalewski, Adrian, BSc</creatorcontrib><creatorcontrib>Nazif, Tamim, MD</creatorcontrib><creatorcontrib>George, Isaac, MD</creatorcontrib><creatorcontrib>Mandava, Anupa, MD</creatorcontrib><creatorcontrib>Baber, Usman, MD</creatorcontrib><creatorcontrib>Dangas, George, MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Kini, Annapoorna S., MD</creatorcontrib><creatorcontrib>Sharma, Samin K., MD</creatorcontrib><title>Impact of Major Bleeding on Long-Term Mortality in Anemic Versus Nonanemic Patients Undergoing Percutaneous Coronary Intervention Using Bivalirudin</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.</description><subject>Acute coronary syndromes</subject><subject>Age</subject><subject>Aged</subject><subject>Anemia</subject><subject>Anemia, Hypochromic - complications</subject><subject>Antithrombins - therapeutic use</subject><subject>Body mass index</subject><subject>Cardiovascular</subject><subject>Diabetes</subject><subject>Female</subject><subject>Heart attacks</subject><subject>Hemorrhage - complications</subject><subject>Hirudins</subject><subject>Humans</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Mortality</subject><subject>Normal distribution</subject><subject>Peptide Fragments - therapeutic use</subject><subject>Percutaneous Coronary Intervention - mortality</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - prevention & control</subject><subject>Recombinant Proteins - 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complications</topic><topic>Antithrombins - therapeutic use</topic><topic>Body mass index</topic><topic>Cardiovascular</topic><topic>Diabetes</topic><topic>Female</topic><topic>Heart attacks</topic><topic>Hemorrhage - complications</topic><topic>Hirudins</topic><topic>Humans</topic><topic>Kidney diseases</topic><topic>Male</topic><topic>Mortality</topic><topic>Normal distribution</topic><topic>Peptide Fragments - therapeutic use</topic><topic>Percutaneous Coronary Intervention - mortality</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - prevention & control</topic><topic>Recombinant Proteins - therapeutic use</topic><topic>Stents</topic><topic>Studies</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ali, Ziad A., MD, DPhil</creatorcontrib><creatorcontrib>Poludasu, Shyam, MD</creatorcontrib><creatorcontrib>Qureshi, Yasir H., MD</creatorcontrib><creatorcontrib>Krishnan, Prakash, MD</creatorcontrib><creatorcontrib>Ali, Ayyaz A., MD</creatorcontrib><creatorcontrib>Tatonetti, Nicholas, PhD</creatorcontrib><creatorcontrib>Downey, Peter, MD</creatorcontrib><creatorcontrib>Zalewski, Adrian, BSc</creatorcontrib><creatorcontrib>Nazif, Tamim, MD</creatorcontrib><creatorcontrib>George, Isaac, MD</creatorcontrib><creatorcontrib>Mandava, Anupa, MD</creatorcontrib><creatorcontrib>Baber, Usman, MD</creatorcontrib><creatorcontrib>Dangas, George, MD</creatorcontrib><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Kini, Annapoorna S., MD</creatorcontrib><creatorcontrib>Sharma, Samin K., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ali, Ziad A., MD, DPhil</au><au>Poludasu, Shyam, MD</au><au>Qureshi, Yasir H., MD</au><au>Krishnan, Prakash, MD</au><au>Ali, Ayyaz A., MD</au><au>Tatonetti, Nicholas, PhD</au><au>Downey, Peter, MD</au><au>Zalewski, Adrian, BSc</au><au>Nazif, Tamim, MD</au><au>George, Isaac, MD</au><au>Mandava, Anupa, MD</au><au>Baber, Usman, MD</au><au>Dangas, George, MD</au><au>Mehran, Roxana, MD</au><au>Kini, Annapoorna S., MD</au><au>Sharma, Samin K., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Major Bleeding on Long-Term Mortality in Anemic Versus Nonanemic Patients Undergoing Percutaneous Coronary Intervention Using Bivalirudin</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2014-05-01</date><risdate>2014</risdate><volume>113</volume><issue>9</issue><spage>1481</spage><epage>1486</epage><pages>1481-1486</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Bleeding complications after percutaneous coronary intervention (PCI) have been associated with higher short and long-term mortality. Bivalirudin has been shown to reduce bleeding complications in patients who underwent PCI; however, the impact of anemia on bleeding complications and long-term mortality has not been studied. A total of 11,991 patients who underwent PCI over a period of 8 years with bivalirudin as the primary antithrombotic agent were included. Anemia was defined according to the World Health Organization definition. Bleeding complications were prospectively collected. Survival analysis was performed using multivariable Cox proportional hazards models. Of the 11,991 patients, 4,815 patients (40%) had baseline anemia. Major bleeding occurred in 3.3% of patients with anemia compared with 0.7% of patients without anemia (p <0.001) driven largely by transfusion events. In the overall study population, major bleeding was a significant predictor of mortality (hazard ratio [HR] 1.4, 95% confidence interval [CI] 1.04 to 1.8, p = 0.027) at a mean follow-up of 2.6 years (interquartile range 1.4 to 3.5). In patients with anemia, major bleeding remained an independent predictor of mortality (HR 1.5, 95% CI 1.1 to 2.0, p = 0.008); however, in patients without anemia, it did not (HR 1.25, 95% CI 0.52 to 3.03, p = 0.62). In patients who underwent PCI with bivalirudin therapy, major bleeding is associated with early and long-term mortality, which is more pronounced in patients with baseline anemia.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24630790</pmid><doi>10.1016/j.amjcard.2014.01.427</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2014-05, Vol.113 (9), p.1481-1486 |
| issn | 0002-9149 1879-1913 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Acute coronary syndromes Age Aged Anemia Anemia, Hypochromic - complications Antithrombins - therapeutic use Body mass index Cardiovascular Diabetes Female Heart attacks Hemorrhage - complications Hirudins Humans Kidney diseases Male Mortality Normal distribution Peptide Fragments - therapeutic use Percutaneous Coronary Intervention - mortality Postoperative Complications - mortality Postoperative Complications - prevention & control Recombinant Proteins - therapeutic use Stents Studies Variables |
| title | Impact of Major Bleeding on Long-Term Mortality in Anemic Versus Nonanemic Patients Undergoing Percutaneous Coronary Intervention Using Bivalirudin |
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