Pre-PCI bleeding risk score predicts greater risk, higher costs

March 26, 2012

A pre-procedure bleeding risk score can accurately identify high-risk, high-cost patients and may provide an opportunity to employ bleeding avoidance strategies to improve patient outcomes and reduce total costs related to percutaneous coronary intervention (PCI) procedures, according to a retrospective study being presented March 26 at the 61st annual American College of Cardiology (ACC) scientific session.

More than 1.3 million PCIs are performed annually in the U.S. Peri-procedure bleeding is the most common non-cardiac complication associated with PCI, occurring in 3 to 6 percent of cases, explained the study's lead author Craig E. Strauss, MD, MPH, a at the Minneapolis Heart Institute at Abbott Northwestern Hospital in Minneapolis and physician researcher with the Minneapolis Heart Institute Foundation. These complications have been shown to increase the length of hospital stay, increase morbidity and mortality, as well as increase the total costs of the hospitalization.

"The risk score assesses patient characteristics before the procedure is performed, and includes symptoms at presentation, history of or prior PCI, age and ," said Strauss. Based on these factors, physicians and the cath lab team categorize patients as low risk, intermediate risk or high risk for bleeding complications associated with the PCI procedure.

Once the patient's characteristics are identified, evaluating his or her risk score takes a matter of minutes, said Strauss. "In addition, the enhanced knowledge of the patient's risk can help guide decision-making for the procedure," he added.

In this study, researchers applied the pre-PCI bleeding to all 8,309 PCI patients at three high-volume hospitals within the Allina Hospitals & Clinics Cardiovascular Service Line between January 2009 and September 2011. Strauss and colleagues calculated bleeding risk scores and grouped cases by low-risk (0-7), intermediate-risk (8-17) and high-risk (18 or more).

Among the 8,309 PCI patients, 15 percent were deemed high-risk, 48 percent intermediate-risk and 37 percent low-risk patients.

Comparing these groups, the high-risk, intermediate-risk and low-risk patients, respectively, had statistically significantly different rates of:

  • Any complication (24.5 percent vs. 7.5 percent vs. 2.4 percent);
  • Hospital length of stay in days (5.2 vs. 2.9 vs. 1.9);
  • Need for blood transfusion (12.3 percent vs. 3.1 percent vs. 0.5 percent);
  • Total costs ($22,821 vs. $14,500 vs. $11,539); and
  • Mortality (6.7 percent vs. 1.2 percent vs. 0.7 percent).
"Employing real-time decision support tools to identify which patients fall into which category of risk prior to the procedure allows interventional cardiologists to tailor the treatment of patients, including selection of anticoagulant therapies and whether or not to use a vascular closure device, for example," said Strauss, adding that these findings contribute to the ever-growing importance of personalized, evidence-based medicine.

Explore further: Same-day discharge after coronary artery stenting safe, yet not used

Related Stories

Same-day discharge after coronary artery stenting safe, yet not used

October 4, 2011
Patients discharged the same day they undergo coronary artery stenting do just as well as patients hospitalized overnight for observation, according to researchers at Duke University Medical Center. And yet, they say, same-day ...

Most PCIs (such as balloon angioplasty) performed in US for acute indications appear warranted

July 5, 2011
In an examination of the appropriateness of the widespread use of percutaneous coronary interventions (PCIs), researchers found that of more than 500,000 PCIs included in the study, nearly all for acute indications were classified ...

Angioplasty may be feasible for liver transplantation candidates with heart disease

June 22, 2011
A small, retrospective study determined that percutaneous coronary intervention (PCI) was safe in patients with significant coronary artery disease (CAD) who were referred for liver transplantation. Larger studies are needed ...

Some 90-year-old heart attack patients have 'excellent' outcomes with coronary stenting

March 25, 2012
Selected patients 90 years and older who experience an acute heart attack, or ST-elevation myocardial infarction (STEMI), have reasonable outcomes with coronary stenting, and should be considered for reperfusion therapy, ...

Recommended for you

Ultra-thin tissue samples could help to understand and treat heart disease

December 12, 2017
A new method for preparing ultra-thin slices of heart tissue in the lab could help scientists to study how cells behave inside a beating heart.

Research reveals how diabetes in pregnancy affects baby's heart

December 12, 2017
Researchers at the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA have discovered how high glucose levels—whether caused by diabetes or other factors—keep heart cells from maturing ...

Young diabetics could have seven times higher risk for sudden cardiac death

December 12, 2017
Young diabetics could have seven times more risk of dying from sudden cardiac arrest than their peers who don't have diabetes, according to new research.

Blood flow–sensing protein protects against atherosclerosis in mice

December 12, 2017
UCLA scientists have found that a protein known as NOTCH1 helps ward off inflammation in the walls of blood vessels, preventing atherosclerosis—the narrowing and hardening of arteries that can cause heart attacks and strokes. ...

Half of people aged 40-54 have hardened arteries: study

December 11, 2017
Half of middle-aged people who are normal weight and don't smoke or have diabetes may have clogged arteries, researchers said Thursday, urging stronger measures to lower cholesterol.

Research suggests new pathways for hyperaldosteronism

December 7, 2017
A new study led by researchers at Sanford Burnham Prebys Medical Discovery Institute (SBP), in collaboration with researchers at Eunice Kennedy Shriver National Institute of Child Health and Human Development, part of the ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.