Bleeding risk assessment in patients with acute ST elevation myocardial infarction after mechanical coronary artery recanalisation, and bleeding influence on outcomes of inpatient treatment

Objective: To evaluate the impact of various factors on bleeding after percutaneous coronary intervention (PCI) and bleeding impact on inpatient treament outcomes in patients with acute ST elevation myocardial infarction (STEMI). Methods: The study sample was composed of the patients hospitalized to the hospital of Lithuanian University of Health Sciences Kauno klinikos Department of Cardiology (n=200) due to acute STEMI. All patients underwent PCI. The risk of periprocedural bleeding of PCI was assessed by using CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines).The severity of bleeding was assessed by using BARC (The Bleeding Academic Research Consortium). The results were analysed with Stiudent t, Mann – Whitney, Fisher´s exact test, Chi square and Spearman´s correlation and were considered statistically significant when p≤0.05. Results: Overall bleeding after PCI occurred in 81 (40.5%) patients. Minor bleeding experienced 69 (85,2%), while major - 12 (14,8%) of them. Overall major bleeding occurred at 6% rate. Bleeding occurred more in ≥65 age group (χ2=10.2; p=0.001) and higher body mass patients (χ2=7.7; p=0.021). Past vascular diseases, number of implanted stents and lower platelet count in blood were associated with more frequent bleeding (χ2=6.23; p=0.013; χ2=4.3; p=0.039 and χ2=13.8; p=0.001). Bleeding occurred less frequently in patients with heart failure signs during hospitalization and higher Killip class (χ2=7.28; p=0.007 and χ2=8.1; p=0.004). Bleeding after PCI was related with longer hospital stays (p=0.004). Conclusions: Overall inhospital bleeding after PCI is not rare. However, major bleeding ocurred at 6% rate and was associated with higher major bleeding risk. Bleeding was associated with older age, higher body mass, past vascular diseases, lower platelet count in blood and number of implanted stents. Heart failure signs during hospitalisation and higher Killip class were associated with less frequent bleeding. Other factors were not associated with bleeding. Bleeding had no significant impact on outcomes of inpatient treatment but was associated with longer hospital stays