Keele Research Repository

Major bleeding is a common complication following percutaneous coronary intervention (PCI), although little is known about how bleeding rates have changed over time and what has driven this. We analyzed all patients undergoing PCI in England and Wales from 2006 to 2013. Multivariate analyses using logistic regression models were performed to identify predictors of bleeding in order to identify potential factors influencing bleeding trends over time. 545,604 participants who had PCI in England and Wales between 2006 and 2013 were included in the analyses. Overall bleeding rates declined from 7.0 (CI:6.2–7.8) per 1000 procedures in 2006 to 5.5 (CI:4.7–6.2) per 1000 in 2013. Increasing age, female sex, GPIIb/IIIa inhibitor use and circulatory support was independently associated with increased risk of bleeding complications whilst radial access and vascular closure device use were independently associated with decreases in risk. Decreases in bleeding rates over time were associated with radial access site, and changes in pharmacology, but this was offset by greater proportion of ACS cases and more the adverse patient clinical demographics. In conclusion, Major bleeding complications after PCI has declined due to changes in access site practice and decreased usage of GPIIb/IIIa inhibitors, but this is offset by the increase of patients with higher propensity to bleed. Changes in access site practice nationally have the potential to significantly reduce major bleeding following PCI.