Bleeding rates post-PCI reveal variation, chance for change

Many hospitals have an opportunity to curb post-PCI bleeding, based on an assessment of CathPCI Registry data that found bleeding rates were wildly variable among participating hospitals.

The research team reviewed hospital performance for hospitals and centers providing 50 PCIs per year or less between 2009 and 2012. While the median unadjusted post-PCI bleeding rate was 5.2 percent, Connie N. Hess, MD, MHS, from the Duke Clinical Research Institute in Durham, N.C., and colleagues found that rates varied widely between the 1,292 registered hospitals. Some hospitals reported rates around 2.6 percent, while others were as high as 10.4 percent, which persisted after adjustment.

They found that patients in hospitals with the highest bleeding rates were more likely to have a history of prior MI and heart failure and presented with STEMI. These patients were more frequently not white and less likely to have had a previous coronary revascularization. Procedures with these patients were more often performed with unfractionated heparin and glycoprotein IIb/IIIa inhibitors.

Median bleeding rates were similar between academic and nonacademic hospitals, 5.4 percent vs. 5.1 percent, respectively. Procedural factors weighed heavily in bleeding rates, with more hospitals using heparin and glycoprotein IIb/IIIa inhibitors having greater bleeding rates.

Hospitals with the lowest bleeding rates used bleeding avoidance strategies, such as bivalirudin, radial access and vascular closure devices, more frequently.

Hess et al noted that with the improvements seen when bleeding avoidance strategies were used, standards of care and best practices needed to be shared among hospitals to improve outcomes across all care facilities. They recommended improving awareness through the inclusion of bleeding avoidance strategies and variables into care algorithms and order sets and incorporating bleeding avoidance strategies into institutional education on care quality indicators.

However, they warned that bleeding rates may have been under or over-reported by some hospitals as bleeding data reporting in the CathPCI registry is voluntary.

Hess et al reminded physicians that understanding and controlling post-PCI bleeding rates is important as it can result in increased patient mortality rates, higher morbidity and increased hospital costs.

This study was published online Nov. 25 in Circulation: Cardiovascular Quality and Outcomes.