LAUSR

Background— In-hospital bleeding after percutaneous coronary intervention is associated with increased mortality. We studied the impact of bleeding severity, defined as magnitude of Hgb (hemoglobin) reduction from baseline (&Dgr;Hgb), on the risk of death and other adverse events. Methods and Results— We studied the association between &Dgr;Hgb, baseline characteristics, and outcomes among 7608 patients in the ADAPT-DES registry (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) who had information on Hgb values before and after they underwent successful percutaneous coronary intervention. Post-percutaneous coronary intervention, 5985 (78.7%) patients had a drop in Hgb, with 2684 patients (35.3%) having a &Dgr;Hgb <1.0 g/dL, 2338 (30.7%) ≥1.0 to <2.0 g/dL, 745 (9.8%) ≥2.0 to <3.0 g/dL, 145 (1.9%) ≥3.0 to <4.0 g/dL, and 73 (1.0%) ≥4.0 g/dL. The risk of dying within 2 years was 3.3% with <1.0 g/dL &Dgr;Hgb, 3.4% with &Dgr;Hgb ≥1.0 to <2.0 g/dL, 3.7% with &Dgr;Hgb ≥2.0 to <3.0 g/dL, 4.1% with &Dgr;Hgb ≥3.0 to <4.0 g/dL, and 9.8% with &Dgr;Hgb ≥4.0 g/dL (P=0.03). The risk of major adverse cardiac events (defined as cardiac death, myocardial infarction, or stent thrombosis) was higher for patients with &Dgr;Hgb ≥4.0 g/dL (adjusted hazard ratio, 3.39; 95% confidence interval, 1.97–5.83; P<0.001) and for patients with &Dgr;Hgb ≥3.0 to <4.0 g/dL (adjusted hazard ratio, 2.17; 95% confidence interval, 1.34–3.53; P=0.002). Conclusions— Among patients who undergo successful percutaneous coronary intervention, bleeding events that result in &Dgr;Hgb ≥4.0 g/dL are associated with a considerably increased risk of dying. Clinical Trial Registration— URL: https://www.clinicaltrials.gov. Unique identifier: NCT00638794.