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

Chun Shing Kwok, Sunil V Rao, Phyo K Myint, Bernard Keavney, James Nolan, Peter F Ludman, Mark A de Belder, Yoon K Loke, Mamas A Mamas

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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.

Original languageEnglish
Article numbere000021
JournalOpen Heart
Volume1
Issue number1
DOIs
Publication statusPublished - 13 Feb 2014

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Percutaneous Coronary Intervention
Meta-Analysis
Hemorrhage
Mortality
MEDLINE

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Major bleeding after percutaneous coronary intervention and risk of subsequent mortality : a systematic review and meta-analysis. / Kwok, Chun Shing; Rao, Sunil V; Myint, Phyo K; Keavney, Bernard; Nolan, James; Ludman, Peter F; de Belder, Mark A; Loke, Yoon K; Mamas, Mamas A.

In: Open Heart, Vol. 1, No. 1, e000021, 13.02.2014.

Research output: Contribution to journalArticle

Kwok, Chun Shing ; Rao, Sunil V ; Myint, Phyo K ; Keavney, Bernard ; Nolan, James ; Ludman, Peter F ; de Belder, Mark A ; Loke, Yoon K ; Mamas, Mamas A. / Major bleeding after percutaneous coronary intervention and risk of subsequent mortality : a systematic review and meta-analysis. In: Open Heart. 2014 ; Vol. 1, No. 1.
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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.",
author = "Kwok, {Chun Shing} and Rao, {Sunil V} and Myint, {Phyo K} and Bernard Keavney and James Nolan and Ludman, {Peter F} and {de Belder}, {Mark A} and Loke, {Yoon K} and Mamas, {Mamas A}",
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T1 - Major bleeding after percutaneous coronary intervention and risk of subsequent mortality

T2 - a systematic review and meta-analysis

AU - Kwok, Chun Shing

AU - Rao, Sunil V

AU - Myint, Phyo K

AU - Keavney, Bernard

AU - Nolan, James

AU - Ludman, Peter F

AU - de Belder, Mark A

AU - Loke, Yoon K

AU - Mamas, Mamas A

PY - 2014/2/13

Y1 - 2014/2/13

N2 - 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.

AB - 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.

U2 - 10.1136/openhrt-2013-000021

DO - 10.1136/openhrt-2013-000021

M3 - Article

VL - 1

JO - Open Heart

JF - Open Heart

SN - 2053-3624

IS - 1

M1 - e000021

ER -