Although bleeding following percutaneous coronary intervention (PCI) has previously been linked with short- and long-term mortality, this association was derived from highly selected randomised controlled trials. This large study used the CathPCI registry to estimate the adjusted population attributable risk of bleeding-related mortality in patients undergoing PCI in the United States.

3 386 688 procedures in the CathPCI Registry performed between 2004 and 2011 were analyzed. The population attributable risk was calculated after adjustment for baseline demographic, clinical, and procedural variables. To calculate the number needed to harm (NNH) for bleeding-related mortality, a propensity-matched analysis was performed.  The main outcome measure was in-hospital mortality.

57 246 bleeding events (1.7%) and 22 165 in-hospital deaths (0.65%) occurred in 3 386 688 PCI procedures.  In the propensity-matched cohort (56 078 procedures with a major bleeding event), major bleeding was associated with increased in-hospital mortality (5.26% vs 1.87%; NNH = 29, P < .001). Although both access-site and non–access-site bleeding were associated with increased in-hospital mortality (2.73% vs 1.87%; NNH = 117, P < .001; and 8.25% vs 1.87%; NNH = 16, P < .001, respectively), the NNH was lower for nonaccess bleeding.  The association between major bleeding and in-hospital mortality was seen in all strata of preprocedural bleeding risk (low: 1.62% vs 0.17%, P < .001; intermediate: 3.27% vs 0.71%, P < .001; and high: 8.16% vs 3.45%, P < .001).

Conclusions:

In this large registry of patients undergoing PCI in the United States, postprocedural bleeding events were associated with an increased risk of in-hospital mortality.  Overall, an estimated 12.1% of deaths were related to bleeding complications.

• Chhatriwall AK, Amin AP, Kennedy KF et al.  Association between bleeding events and in-hospital mortality after percutaneous coronary intervention.  JAMA 2013;309:1022-1029