ACCESS VERSUS NON-ACCESS SITE MAJOR BLEEDING AND IN-HOSPITAL OUTCOMES AMONG STEMI PATIENTS RECEIVING PRIMARY PCI

ABSTRACT Background Major bleeding (MB) is an independent predictor of mortality among ST-elevation myocardial infarction (STEMI) patients undergoing primary PCI (pPCI). There has been significant focus on preventing access site MB. However, limited data exist on the influence of access site MB vs non-access site MB and subsequent association with adverse in-hospital outcomes in the STEMI population undergoing pPCI. Methods We identified 1494 STEMI patients who underwent pPCI between 2012 and 2018. Unadjusted and adjusted differences among patients with no MB, access site MB, non-access site MB, and in-hospital clinical outcomes were assessed. The use of bleeding avoidance strategies (BAS) and their effects on MB was also evaluated. Results MB occurred in 121 (8.1%) patients. Access site MB occurred in 34 (2.3%) patients and non-access site MB occurred in 87 (5.8%). The median reduction in hemoglobin was 31 g/L (IQR 19-43) with access site MB and 44 g/L (IQR 29-62) with non-access site MB. After multivariable adjustment, non-access site MB was independently associated with in-hospital death (aOR 4.21; 95%CI 2.04-8.68), cardiogenic shock (aOR 10.91; 95% CI 5.67-20.98), and cardiac arrest (aOR 5.63; 95% CI 2.88-11.01). Conversely, access site MB was not associated with adverse in-hospital outcomes. BAS were used frequently; however, after multivariable adjustment, no single BAS was significantly associated with reduced MB. Conclusion In STEMI patients undergoing pPCI, non-access site MB was independently associated with adverse in-hospital outcomes, whereas access site MB was not. Additional study of strategies to reduce the incidence and impact of non-access site MB appears warranted.