PMID- 27101904 OWN - NLM STAT- MEDLINE DCOM- 20170117 LR - 20191210 IS - 1876-7605 (Electronic) IS - 1936-8798 (Linking) VI - 9 IP - 8 DP - 2016 Apr 25 TI - The Impact of Bleeding Avoidance Strategies on Hospital-Level Variation in Bleeding Rates Following Percutaneous Coronary Intervention: Insights From the National Cardiovascular Data Registry CathPCI Registry. PG - 771-779 LID - S1936-8798(16)00162-X [pii] LID - 10.1016/j.jcin.2016.01.033 [doi] AB - OBJECTIVES: The aim of this study was to explore whether the use of bleeding avoidance strategies (BAS) explains variability in hospital-level bleeding following percutaneous coronary intervention. BACKGROUND: Prior studies have reported that bleeding rates following percutaneous coronary intervention vary markedly among hospitals, but the extent to which use of BAS explains this variation is unknown. METHODS: Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, estimated hospital-level bleeding rates from 2,459,686 procedures at 1,358 sites were determined. A series of models were fit to estimate random-effect variance, adjusting for patient risk (using the validated CathPCI bleeding risk model, C statistic = 0.77) and various combinations of BAS (transradial access, bivalirudin, vascular closure device use). The rate of any BAS use was also estimated for each hospital, and the association between percentage BAS use and predicted bleeding rates was determined. RESULTS: In total, 125,361 bleeding events (5.1%) were observed; patients experiencing bleeding events had lower rates of radial access (5.0% vs. 11.2%; p < 0.001), bivalirudin therapy (43.8% vs. 59.4%), and vascular closure device use (32.9% vs. 42.4%, p < 0.001) than those without bleeding. There was significant variation in bleeding rates across hospitals (median 5.0%; interquartile range [IQR]: 2.7% to 6.6%), which persisted after incorporating patient-level risk (median 5.1%; IQR: 4.0% to 4.4%). Patient factors accounted for 20% of the overall hospital-level variation, and radial access plus bivalirudin use accounted for an additional 7.8% of the overall hospital-level variation. The median hospital rate of any BAS use was 86.6% (IQR: 72.5% to 94.1%). A significant decrease in observed hospital-level bleeding was seen in hospitals above the median in BAS use (adjusted odds ratio: 0.90; 95% confidence interval: 0.88 to 0.93). CONCLUSIONS: A modest proportion of the variation in hospitals' rates of bleeding following percutaneous coronary intervention is attributable to differential use of BAS. Further analyses are required to determine the remaining approximately 70% causes of variation in percutaneous coronary intervention bleeding seen among hospitals. CI - Copyright (c) 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. FAU - Vora, Amit N AU - Vora AN AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. Electronic address: a.vora@duke.edu. FAU - Peterson, Eric D AU - Peterson ED AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - McCoy, Lisa A AU - McCoy LA AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - Garratt, Kirk N AU - Garratt KN AD - Center for Heart and Vascular Health, Christiana Care Health System, Wilmington, Delaware. FAU - Kutcher, Michael A AU - Kutcher MA AD - Wake Forest University School of Medicine, Winston-Salem, North Carolina. FAU - Marso, Steven P AU - Marso SP AD - University of Texas Southwestern Medical Center, Dallas, Texas. FAU - Roe, Matthew T AU - Roe MT AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. FAU - Messenger, John C AU - Messenger JC AD - Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado. FAU - Rao, Sunil V AU - Rao SV AD - Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina. LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PL - United States TA - JACC Cardiovasc Interv JT - JACC. Cardiovascular interventions JID - 101467004 RN - 0 (Antithrombins) RN - 0 (Hirudins) RN - 0 (Peptide Fragments) RN - 0 (Recombinant Proteins) RN - TN9BEX005G (bivalirudin) SB - IM CIN - JACC Cardiovasc Interv. 2016 Apr 25;9(8):780-3. PMID: 27101905 EIN - JACC Cardiovasc Interv. 2016 Jul 25;9(14):1522. PMID: 27478127 MH - Aged MH - Antithrombins/therapeutic use MH - Cardiac Catheterization/adverse effects/methods/*trends MH - Catheterization, Peripheral/trends MH - Chi-Square Distribution MH - Female MH - Healthcare Disparities/*trends MH - Hemorrhage/diagnosis/epidemiology/*prevention & control MH - Hirudins MH - Hospitals/*trends MH - Humans MH - Logistic Models MH - Male MH - Middle Aged MH - Odds Ratio MH - Peptide Fragments/therapeutic use MH - Percutaneous Coronary Intervention/adverse effects/methods/*trends MH - Practice Patterns, Physicians'/*trends MH - Process Assessment, Health Care/*trends MH - Radial Artery MH - Recombinant Proteins/therapeutic use MH - Registries MH - Risk Assessment MH - Risk Factors MH - Treatment Outcome MH - United States/epidemiology MH - Vascular Closure Devices OTO - NOTNLM OT - PCI OT - bleeding avoidance OT - performance measure OT - quality measure EDAT- 2016/04/23 06:00 MHDA- 2017/01/18 06:00 CRDT- 2016/04/23 06:00 PHST- 2015/12/22 00:00 [received] PHST- 2016/01/14 00:00 [accepted] PHST- 2016/04/23 06:00 [entrez] PHST- 2016/04/23 06:00 [pubmed] PHST- 2017/01/18 06:00 [medline] AID - S1936-8798(16)00162-X [pii] AID - 10.1016/j.jcin.2016.01.033 [doi] PST - ppublish SO - JACC Cardiovasc Interv. 2016 Apr 25;9(8):771-779. doi: 10.1016/j.jcin.2016.01.033.