The rate of hemorrhagic complications and their prevention in patients with ST-segment elevation myocardial infarction undergoing invasive management: Results of a single-center observational study

• Vasily V. Kashtalap
• Kochergina A.M.
• V.O. Leonova
• V.Yu. Kheraskov
• O.L. Barbarash

Abstract

Purpose - to assess the rate and clinical predictors of hemorrhagic complications during primary percutaneous coro­nary intervention (PCI) in patients with ST-segment elevation myocardial infarction (MI).

Material and methods. 388 STEMI patients admitted to the Kemeorovo Regional Vascular Center in 2012 were included in the study. The mean age of patients was 60.48±10.93 years. All patients underwent emergency coronary angiography to deter­mine the indications for primary PCI as a myocardial revascularization method. The actual rate and initial risk of hemorrhagic complications were assessed using the CRUSADE, ACTION, REACH bleeding risk scales. Hemorrhagic complication was defined as any bleeding in MI patients during the in-hospital period, including hematoma after catheterization procedure.

Results. There were 40 (10.3%) cases of hemorrhagic complications in the study sample. The development of hemorrhag­ic complications was associated with age (66.73±8.55 years in the group with hemorrhagic complications vs. 59.77±10.95 years in the group without hemorrhagic complications, p=0.0001); with female sex (62.5% of women in the group with com­plications vs. 25.58% - in the group without complications, p=0.000), with a positive history of myocardial infarction (25% vs. 13.5%, respectively, p=0.0517). Patients with hemorrhagic complications at the time of admission hadlower glomerular filtration rate (GFR)levels, compared to patients without hemorrhagic complications (59.07±18.32 vs. 72.1±20.38 ml/min/m², p=0.0001). The incidence of bleedings was associated with higher in-hospital mortality (12.5% in the group with bleedings vs. 3.16% in the group without it, p=0.0049). The efficiency of the ACTION bleeding risk scale at the time of patients' admis­sion was confirmed. Transradial (TR) access for coronary angiography (CAG) in the group of MI patients with hemorrhagic complications wasless frequently used than in patients without hemorrhagic complications (25.71% vs. 45.79%, p=0.0072).

Conclusion: The rate of in-hospital bleedings after ST-segment elevation myocardial infarction was 10.3%. The predic­tors of hemorrhagic complications determined in the current study should be used in the risk management activities aimed at the prevention of their development.

Keywords:myocardial infarction, percutaneous coronary intervention, hemorrhagic complications, risk factors

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