Meghana Iyer, Ankur Kalra, Khaled Ziada, Jacqueline Tamis-Holland, Leslie Cho, Rishi Puri, Stephen G Ellis, Umesh N Khot, Amar Krishnaswamy, Samir Kapadia, Grant W Reed
{"title":"经皮冠状动脉介入治疗后的抽血、输液和出血事件。","authors":"Meghana Iyer, Ankur Kalra, Khaled Ziada, Jacqueline Tamis-Holland, Leslie Cho, Rishi Puri, Stephen G Ellis, Umesh N Khot, Amar Krishnaswamy, Samir Kapadia, Grant W Reed","doi":"10.1002/ccd.31712","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry reports bleeding events within 72-h of percutaneous coronary intervention (PCI) as a quality metric. It is plausible that NCDR post-PCI bleeding events may be influenced by markers of intensity of patient care not related to PCI quality. The relationship between iatrogenic phlebotomy, intravenous fluid input, and post-PCI bleeding events is unknown.</p><p><strong>Methods: </strong>This is a patient-level, observational study of 13,553 PCI procedures at a single center between 6/11/2009 and 6/14/2017. Multivariable logistic regression determined associations between NCDR bleeding events, total oral and intravenous fluid volume input, and number of lab tubes drawn on day of PCI up to 72-h post PCI. Improvement in discriminatory ability of adding these variables to a bleeding risk model was assessed with C-statistic.</p><p><strong>Results: </strong>There were 767 (5.7%) bleeding events. Every 100 mL input was independently associated with 2.0% increased odds of bleeding (odds ratio [OR] 1.01-1.03, p < 0.001). Every 3 mL lab tube drawn was independently associated with 8.1% increased odds (OR 1.07-1.09, p < 0.001). A multivariable model including baseline patient characteristics and PCI variables achieved good discriminatory ability (C-statistic 0.858), but with addition of input, number of lab draws, and length of stay (LOS) achieved an excellent discriminatory ability (C-statistic 0.927, p < 0.001 comparing C-statistics).</p><p><strong>Conclusions: </strong>Variables reflecting intensity of patient illness including frequency of lab draws and fluid intake within 72-h of PCI significantly improve the ability of models to predict NCDR post-PCI bleeding events. Consideration should be given to risk-adjusting for lab draws and fluid administration when nationally reporting bleeding event rates.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Blood Draws, Fluid Input, and Bleeding Events After Percutaneous Coronary Intervention.\",\"authors\":\"Meghana Iyer, Ankur Kalra, Khaled Ziada, Jacqueline Tamis-Holland, Leslie Cho, Rishi Puri, Stephen G Ellis, Umesh N Khot, Amar Krishnaswamy, Samir Kapadia, Grant W Reed\",\"doi\":\"10.1002/ccd.31712\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry reports bleeding events within 72-h of percutaneous coronary intervention (PCI) as a quality metric. It is plausible that NCDR post-PCI bleeding events may be influenced by markers of intensity of patient care not related to PCI quality. The relationship between iatrogenic phlebotomy, intravenous fluid input, and post-PCI bleeding events is unknown.</p><p><strong>Methods: </strong>This is a patient-level, observational study of 13,553 PCI procedures at a single center between 6/11/2009 and 6/14/2017. Multivariable logistic regression determined associations between NCDR bleeding events, total oral and intravenous fluid volume input, and number of lab tubes drawn on day of PCI up to 72-h post PCI. Improvement in discriminatory ability of adding these variables to a bleeding risk model was assessed with C-statistic.</p><p><strong>Results: </strong>There were 767 (5.7%) bleeding events. Every 100 mL input was independently associated with 2.0% increased odds of bleeding (odds ratio [OR] 1.01-1.03, p < 0.001). Every 3 mL lab tube drawn was independently associated with 8.1% increased odds (OR 1.07-1.09, p < 0.001). A multivariable model including baseline patient characteristics and PCI variables achieved good discriminatory ability (C-statistic 0.858), but with addition of input, number of lab draws, and length of stay (LOS) achieved an excellent discriminatory ability (C-statistic 0.927, p < 0.001 comparing C-statistics).</p><p><strong>Conclusions: </strong>Variables reflecting intensity of patient illness including frequency of lab draws and fluid intake within 72-h of PCI significantly improve the ability of models to predict NCDR post-PCI bleeding events. Consideration should be given to risk-adjusting for lab draws and fluid administration when nationally reporting bleeding event rates.</p>\",\"PeriodicalId\":520583,\"journal\":{\"name\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/ccd.31712\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/ccd.31712","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Blood Draws, Fluid Input, and Bleeding Events After Percutaneous Coronary Intervention.
Background: The American College of Cardiology (ACC) National Cardiovascular Data Registry (NCDR) CathPCI Registry reports bleeding events within 72-h of percutaneous coronary intervention (PCI) as a quality metric. It is plausible that NCDR post-PCI bleeding events may be influenced by markers of intensity of patient care not related to PCI quality. The relationship between iatrogenic phlebotomy, intravenous fluid input, and post-PCI bleeding events is unknown.
Methods: This is a patient-level, observational study of 13,553 PCI procedures at a single center between 6/11/2009 and 6/14/2017. Multivariable logistic regression determined associations between NCDR bleeding events, total oral and intravenous fluid volume input, and number of lab tubes drawn on day of PCI up to 72-h post PCI. Improvement in discriminatory ability of adding these variables to a bleeding risk model was assessed with C-statistic.
Results: There were 767 (5.7%) bleeding events. Every 100 mL input was independently associated with 2.0% increased odds of bleeding (odds ratio [OR] 1.01-1.03, p < 0.001). Every 3 mL lab tube drawn was independently associated with 8.1% increased odds (OR 1.07-1.09, p < 0.001). A multivariable model including baseline patient characteristics and PCI variables achieved good discriminatory ability (C-statistic 0.858), but with addition of input, number of lab draws, and length of stay (LOS) achieved an excellent discriminatory ability (C-statistic 0.927, p < 0.001 comparing C-statistics).
Conclusions: Variables reflecting intensity of patient illness including frequency of lab draws and fluid intake within 72-h of PCI significantly improve the ability of models to predict NCDR post-PCI bleeding events. Consideration should be given to risk-adjusting for lab draws and fluid administration when nationally reporting bleeding event rates.