Increased bleeding risk during percutaneous coronary interventions by arterial hypertension

Catheter Cardiovasc Interv. 2016 Aug;88(2):184-90. doi: 10.1002/ccd.26272. Epub 2015 Nov 3.

Abstract

Objectives: We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI).

Background: The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown.

Methods: This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI.

Results: Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P < 0.001). Access-site bleeding occurred in 730 patients with arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P < 0.001), access-site bleeding (adjusted OR = 1.36 [1.10-1.68], P = 0.005) and non-access-site bleeding (adjusted OR = 1.42 [1.09-1.83], P = 0.008). A history of arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018).

Conclusions: Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc.

Keywords: arterial hypertension; bleeding; coronary artery disease; percutaneous coronary intervention.

MeSH terms

  • Aged
  • Antihypertensive Agents / therapeutic use
  • Arterial Pressure* / drug effects
  • Catheterization, Peripheral / adverse effects*
  • Catheterization, Peripheral / mortality
  • Chi-Square Distribution
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / therapy*
  • Female
  • Femoral Artery*
  • Hemorrhage / etiology*
  • Hemorrhage / mortality
  • Humans
  • Hypertension / complications*
  • Hypertension / drug therapy
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Odds Ratio
  • Percutaneous Coronary Intervention / adverse effects*
  • Percutaneous Coronary Intervention / mortality
  • Proportional Hazards Models
  • Punctures
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Antihypertensive Agents