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Kwok CS, Kontopantelis E, Kinnaird T, Potts J, Rashid M, Shoaib A, Nolan J, Bagur R, de Belder MA, Ludman P, Mamas MA. Retroperitoneal Hemorrhage After Percutaneous Coronary Intervention: Incidence, Determinants, and Outcomes as Recorded by the British Cardiovascular Intervention Society. Circ Cardiovasc Interv 2019; 11:e005866. [PMID: 29445000 DOI: 10.1161/circinterventions.117.005866] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 12/14/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Retroperitoneal hemorrhage (RH) is a rare bleeding complication of percutaneous coronary intervention, which can result as a consequence of femoral access or can occur spontaneously. This study aims to evaluate temporal changes in RH, its predictors, and clinical outcomes in a national cohort of patients undergoing percutaneous coronary intervention in the United Kingdom. METHODS AND RESULTS We analyzed RH events in patients who underwent percutaneous coronary intervention between 2007 and 2014. Multiple logistic regression models were used to identify factors associated with RH and to quantify the association between RH and 30-day mortality and major adverse cardiovascular events. A total of 511 106 participants were included, and 291 in hospital RH events were recorded (0.06%). Overall, rates of RH declined from 0.09% to 0.03% between 2007 and 2014. The strongest independent predictors of RH events were femoral access (odds ratio [OR], 19.66; 95% confidence interval [CI], 11.22-34.43), glycoprotein IIb/IIIa inhibitor (OR, 2.63; 95% CI, 1.99-3.47), and warfarin use (OR, 2.53; 95% CI, 1.07-5.99). RH was associated with a significant increase in 30-day mortality (OR, 3.59; 95% CI, 2.19-5.90) and in-hospital major adverse cardiovascular events (OR, 5.76; 95% CI, 3.71-8.95). A legacy effect was not observed; patients with RH who survived 30 days did not have higher 1-year mortality compared with those without this complication (hazard ratio, 0.97; 95% CI, 0.49-1.91). CONCLUSIONS Our results suggest that RH is a rare event that is declining in the United Kingdom, related to transition to transradial access site utilization, but remains a clinically important event associated with increased 30-day mortality but no long-term legacy effect.
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Affiliation(s)
- Chun Shing Kwok
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Evangelos Kontopantelis
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Tim Kinnaird
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Jessica Potts
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Muhammad Rashid
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Ahmad Shoaib
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - James Nolan
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Rodrigo Bagur
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Mark A de Belder
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Peter Ludman
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.)
| | - Mamas A Mamas
- From the Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom (C.S.K., J.P., M.R., A.S., J.N., R.B., M.A.M.); Academic Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom (C.S.K., A.S., J.N., M.A.M.); Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom (E.K.); Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom (T.K.); The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.).
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