Predictors of Bleeding Complications After Rescue Coronary Interventions

Abstract

The purpose of this study was to determine predictors of bleeding complications after current rescue coronary interventions including stenting and adjunctive platelet inhibitors. Previous studies of rescue angioplasty for thrombolytic failure have identified variable rates of bleeding complications with balloon angioplasty alone. Although coronary stents and glycoprotein 2b/3a inhibitors have been shown to improve outcome in a wide variety of coronary interventions, the impact of these therapies on bleeding complications after rescue coronary intervention has not been determined. From 1996 through 1998, we treated 108 consecutive patients with rescue coronary intervention (defined as attempted coronary intervention within 12 hours of thrombolysis for ongoing symptoms or electrocardiogram [ECG] changes) including conventional percutaneous transluminal coronary artery (PTCA), stenting (n=45), and glycoprotein 2b/3a inhibitor use (n=31). In-hospital clinical outcomes were obtained in all patients, and univariate and multivariate predictors of bleeding complications were identified. In hospital, moderate to severe bleeding complications occurred in 17.6% of the cohort, but the rate of severe bleeding complications (2.7%) and vascular repair (1.9%) were low. Independent predictors of bleeding complications were age >60y, female gender, cardiogenic shock, and streptokinase use. Neither the delayed use of abciximab (on average 4 hours after thrombolytic therapy initiation) nor the use of rescue stenting were predictors of increased moderate to severe bleeding complications. Current rescue coronary intervention, including stents and platelet inhibitors, is associated with a low rate of severe bleeding complications. Moderate to severe bleeding complications were more common in selected subgroups of patients but not increased significantly by stenting or delayed abciximab use.