The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk

Keun Ho Park, Myung Ho Jeong, Youngkeun Ahn, Sang Sik Jung, Moo Hyun Kim, Hyoung Mo Yang, Junghan Yoon, Seung Woon Rha, Keum Soo Park, Kyoo Rok Han, Byung Ryul Cho, Kwang Soo Cha, Byung Ok Kim, Min Soo Hyon, Won Yong Shin, Hyunmin Choe, Jang Whan Bae, Hee Yeol Kim

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Abstract

The aim of our study was to determine the impact of vascular access on in-hospital major bleeding (IHMB) in acute coronary syndrome (ACS). We analyzed 995 patients with non-ST elevation myocardial infarction and unstable angina at the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) moderate- to very high-bleeding risk scores in trans-radial intervention (TRI) retrospective registry from 16 centers in Korea. A total of 402 patients received TRI and 593 patients did trans-femoral intervention (TFI). The primary end-point was IHMB as defined in the CRUSADE. There were no significant differences in in-hospital and 1-yr mortality rates between two groups. However, TRI had lower incidences of IHMB and blood transfusion than TFI (6.0% vs 9.4%, P = 0.048; 4.5% vs 9.4%, P = 0.003). The patients suffered from IHMB had higher incidences of in-hospital and 1-yr mortality than those free from IHMB (3.1% vs 15.0%, P < 0.001; 7.2% vs 30.0%, P < 0.001). TRI was an independent negative predictor of IHMB (odds ratio, 0.305; 95% confidence interval, 0.109-0.851; P = 0.003). In conclusions, IHMB is still significantly correlated with in-hospital and 1-yr mortality. Our study suggests that compared to TFI, TRI could reduce IHMB in patients with ACS at moderate- to very high-bleeding risk.

Original languageEnglish
Pages (from-to)1307-1315
Number of pages9
JournalJournal of Korean medical science
Volume28
Issue number9
DOIs
Publication statusPublished - 2013

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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    Park, K. H., Jeong, M. H., Ahn, Y., Jung, S. S., Kim, M. H., Yang, H. M., Yoon, J., Rha, S. W., Park, K. S., Han, K. R., Cho, B. R., Cha, K. S., Kim, B. O., Hyon, M. S., Shin, W. Y., Choe, H., Bae, J. W., & Kim, H. Y. (2013). The impact of vascular access for in-hospital major bleeding in patients with acute coronary syndrome at moderate- to very high-bleeding risk. Journal of Korean medical science, 28(9), 1307-1315. https://doi.org/10.3346/jkms.2013.28.9.1307