Bleeding Severity After Percutaneous Coronary Intervention

Background-In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (Delta Hgb), on the risk of death and other adverse events. Methods and Results-We studied the association between Delta Hgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Postpercutaneous coronary intervention, 5985 (78.7%) patients had a drop in Hgb, with 2684 patients (35.3%) having a Delta Hgb < 1.0 g/dL, 2338 (30.7%) >= 1.0 to < 2.0 g/dL, 745 (9.8%) >= 2.0 to < 3.0 g/dL, 145 (1.9%) >= 3.0 to < 4.0 g/dL, and 73 (1.0%) >= 4.0 g/dL. The risk of dying within 2 years was 3.3% with < 1.0 g/dL Delta Hgb, 3.4% with Delta Hgb >= 1.0 to < 2.0 g/dL, 3.7% with Delta Hgb >= 2.0 to < 3.0 g/dL, 4.1% with Delta Hgb >= 3.0 to < 4.0 g/dL, and 9.8% with Delta Hgb >= 4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with Delta Hgb >= 4.0 g/dL (adjusted hazard ratio, 3.39; 95% confidence interval, 1.97-5.83; P<0.001) and for patients with Delta Hgb >= 3.0 to < 4.0 g/dL (adjusted hazard ratio, 2.17; 95% confidence interval, 1.34-3.53; P=0.002). Conclusions-Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in Delta Hgb >= 4.0 g/dL are associated with a considerably increased risk of dying.