View Full Version : Wide Variation in Hospital Bleeding Rates Post-PCI: CathPCI Registry

Thu 30th July '15, 11:50am
Michael O'Riordan (http://www.medscape.com/author/michael-oriordan)
December 03, 2014

DURHAM, NC — An analysis of nearly two million PCIs shows the rate of bleeding varies extensively across US hospitals, ranging from 2.1% at the best-performing hospitals to just over 10% for the worst[1]. The variation was attenuated after adjustment for patient characteristics, but substantial differences in post-PCI bleeding rates still remained across US centers, say investigators.

The use of bleeding-avoidance strategies, such as using bivalirudin, performing PCI via the radial artery, or using vascular closure devices, also varied among the 1292 hospitals included in the CathPCI Registry (https://www.ncdr.com/webncdr/cathpci/home).

The analysis, which was led by Dr Connie Hess (Duke Clinical Research Institute, Durham, NC) and published November 25, 2014 in Circulation: Cardiovascular and Quality Outcomes, supports the use of PCI-related bleeding complications as a performance measure in the CathPCI Registry and the potential incorporation of the quality metric into other PCI registries, say investigators.

Overall, the unadjusted median rate of bleeding was 5.2%. For centers in the fifth and 95th percentile, the bleeding rates ranged from 2.6% to 10.4%, respectively. When the CathPCI Registry risk model was applied to adjust for case mix, the bleeding rates in the fifth and 95th percentile were 2.8% and 9.4%, respectively. Median bleeding rates at academic and nonacademic hospitals were similar (5.4% vs 5.1%, respectively). Increasing use of heparin or GP IIb/IIIa inhibitors were associated with greater bleeding risk, while use of bivalirudin, radial PCI, or a vascular-closure device reduced the bleeding risk.

"Our results also suggest that provider decisions on procedure methods, such as [bleeding-avoidance strategies],may be useful to reduce PCI bleeding," according to Hess and colleagues. "Ultimately, quality-improvement initiatives to reduce post-PCI bleeding, perhaps through wide implementation of [bleeding-avoidance strategies] and sharing of practices from best-performing sites, might lead to improved PCI outcomes, although further investigation is needed."

Source: http://www.medscape.com/viewarticle/835816?nlid=71683_1986&src=wnl_edit_medn_card&uac=180112PN&spon=2