Predictors of bleeding complications after rescue coronary interventions

The purpose of this study was to determine predictors of bleeding complicat ions after current rescue coronary interventions including stenting and adj unctive platelet inhibitors. Previous studies of rescue angioplasty for thr ombolytic failure have identified variable rates of bleeding complications with balloon angioplasty alone. Although coronary stents and glycoprotein 2 b/3a inhibitors have been shown to improve outcome in a wide variety of cor onary interventions, the impact of these therapies on bleeding complication s after rescue coronary intervention has not been determined. From 1996 thr ough 1998, we treated 108 consecutive patients with rescue coronary interve ntion (defined as attempted coronary intervention within 12 hours of thromb olysis for ongoing symptoms or electrocardiogram [ECG] changes) including c onventional percutaneous transluminal coronary artery (PTCA), stenting (n=4 5), and glycoprotein 2b/3a inhibitor use (n=31). In-hospital clinical outco mes were obtained in all patients, and univariate and multivariate predicto rs of bleeding complications were identified. In hospital, moderate to seve re bleeding complications occurred in 17.6% of the cohort, but the rate of severe bleeding complications (2.7%) and vascular repair (1.9%) were low. I ndependent predictors of bleeding complications were age > 60[emsp4 ]y, fem ale gender, cardiogenic shock, and streptokinase use. Neither the delayed u se of abciximab (on average 4 hours after thrombolytic therapy initiation) nor the use of rescue stenting were predictors of increased moderate to sev ere bleeding complications. Current rescue coronary intervention, including stents and platelet inhibitors, is associated with a low rate of severe bl eeding complications. Moderate to severe bleeding complications were more c ommon in selected subgroups of patients but not increased significantly by stenting or delayed abciximab use.