Impact of vascular access on outcome after PCI in patients at high bleeding risk: a pre-specified sub-analysis of the LEADERS FREE trial
Rev. esp. de cardiol. (Internet. Engl. ed.)
; 73(7): 536-545, set., 2019. tab, graf
Article
in English
| Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP
| ID: biblio-1022212
Responsible library:
BR79.1
Localization: BR79.1
ABSTRACT
INTRODUCTION AND OBJECTIVES:
The prognostic impact of bleeding in high bleeding risk (HBR) patients depending on the location of bleeding and prognosis in nonaccess site bleeding is unknown. We aimed to assess the impact of vascular access site on bleeding complications after percutaneous coronary interventions for HBR patients at 30-day and 2-year follow-up.METHODS:
The LEADERS FREE trial included 2432 HBR PCI patients. A Biolimus A9 drug-coated stent was superior to a bare-metal stent for safety and efficacy. This is a predefined sub-analysis of the LEADERS FREE trial.RESULTS:
Transradial access (TRA) was used in 1454 patients (59.8%) and transfemoral access (TFA) in 978 (40.2%), according to operator preference. The safety and benefits of drug-coated stents over bare-metal stents were independent of vascular access. At 30 days and 2 years, major bleeding had occurred in 2.4% and 7.5% of TRA patients and 4.6% and 10.9% of TFA patients (P=.003), respectively. Most of these events in both groups (2.1% and 7.0% for TRA; 3.2% and 9.4% for TFA, respectively) were nonaccess site-related. TRA was associated with a significant reduction in adjusted rates of major bleeding both at 30 days (HR, 1.98; 95%CI, 1.25-3.11; P=.003) and at 2 years of follow-up (HR, 1.51; 95%CI, 1.14-2.01; P=.003). This difference was driven by both access and nonaccess bleeding.CONCLUSIONS:
Operators preferred TRA for most HBR patients, which was associated with a significant reduction in major bleeding events. However, most of these events in this population are unrelated to vascular access. (AU)
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Collection:
National databases
/
Brazil
Database:
Sec. Est. Saúde SP
/
SESSP-IDPCPROD
Main subject:
Percutaneous Coronary Intervention
Type of study:
Etiology study
/
Risk factors
Language:
English
Journal:
Rev. esp. de cardiol. (Internet. Engl. ed.)
Year:
2019
Document type:
Article
Institution/Affiliation country:
Biosensors Europe/CH
/
Clinique de Fontaine/FR
/
Générale de Santé/FR
/
Hospital Universitario de Vigo/ES
/
Hôpital Privé Jacques Cartier/FR
/
Hôpital de la Tour/CH
/
Instituto Dante Pazzanese de Cardiologia/BR
/
King's College/GB
/
Ospedale Bolognini/IT
/
Prince Charles Hospital/AU