TY - JOUR
T1 - An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention
T2 - A report using an expanded bleeding definition from the national cardiovascular data registry CathPCI registry
AU - Rao, Sunil V.
AU - McCoy, Lisa A.
AU - Spertus, John A.
AU - Krone, Ronald J.
AU - Singh, Mandeep
AU - Fitzgerald, Susan
AU - Peterson, Eric D.
N1 - Funding Information:
This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR) . The views expressed in this manuscript represent those of the author(s), and do not necessarily represent the official views of the NCDR or its associated professional societies identified at www.ncdr.com . Dr. Rao is a consultant for The Medicines Company and Terumo Medical. Dr. Spertus has received grants from Eli Lilly, Genentech, Bristol-Myers Squibb, and Sanofi-Aventis; a research contract from the American College of Cardiology Foundation; and an equity position in Health Outcomes Sciences. Dr. Peterson has received research funding from Eli Lilly and Janssen . Pharmaceuticals. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/9
Y1 - 2013/9
N2 - Objectives This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. Background New knowledge about the importance of periprocedural bleeding combined with techniques to mitigate its occurrence and the inclusion of new data in the updated CathPCI Registry data collection forms encouraged us to develop a new bleeding definition and risk model to improve the monitoring and safety of PCI. Methods Detailed clinical data from 1,043,759 PCI procedures at 1,142 centers from February 2008 through April 2011 participating in the CathPCI Registry were used to identify factors associated with major bleeding complications occurring within 72 h post-PCI. Risk models (full and simplified risk scores) were developed in 80% of the cohort and validated in the remaining 20%. Model discrimination and calibration were assessed in the overall population and among the following pre-specified patient subgroups: females, those older than 70 years of age, those with diabetes mellitus, those with ST-segment elevation myocardial infarction, and those who did not undergo in-hospital coronary artery bypass grafting. Results Using the updated definition, the rate of bleeding was 5.8%. The full model included 31 variables, and the risk score had 10. The full model had similar discriminatory value across pre-specified subgroups and was well calibrated across the PCI risk spectrum. Conclusions The updated bleeding definition identifies important post-PCI bleeding events. Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.
AB - Objectives This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. Background New knowledge about the importance of periprocedural bleeding combined with techniques to mitigate its occurrence and the inclusion of new data in the updated CathPCI Registry data collection forms encouraged us to develop a new bleeding definition and risk model to improve the monitoring and safety of PCI. Methods Detailed clinical data from 1,043,759 PCI procedures at 1,142 centers from February 2008 through April 2011 participating in the CathPCI Registry were used to identify factors associated with major bleeding complications occurring within 72 h post-PCI. Risk models (full and simplified risk scores) were developed in 80% of the cohort and validated in the remaining 20%. Model discrimination and calibration were assessed in the overall population and among the following pre-specified patient subgroups: females, those older than 70 years of age, those with diabetes mellitus, those with ST-segment elevation myocardial infarction, and those who did not undergo in-hospital coronary artery bypass grafting. Results Using the updated definition, the rate of bleeding was 5.8%. The full model included 31 variables, and the risk score had 10. The full model had similar discriminatory value across pre-specified subgroups and was well calibrated across the PCI risk spectrum. Conclusions The updated bleeding definition identifies important post-PCI bleeding events. Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.
KW - bleeding complications
KW - bleeding risk models
KW - percutaneous coronary intervention
KW - quality improvement
UR - http://www.scopus.com/inward/record.url?scp=84884374877&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2013.04.016
DO - 10.1016/j.jcin.2013.04.016
M3 - Review article
C2 - 24050858
AN - SCOPUS:84884374877
SN - 1936-8798
VL - 6
SP - 897
EP - 904
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 9
ER -