Retroperitoneal hemorrhage after percutaneous coronary intervention in the current practice era: Clinical outcomes and prognostic value of abdominal/pelvic computed tomography

• Published in: Catheterization and cardiovascular interventions Vol. 80; no. 1; pp. 29 - 36
• Main Authors: Maluenda, Gabriel, Mitulescu, Lavinia, Ben-Dor, Itsik, A. Gaglia Jr, Michael, Weissman, Gaby, Torguson, Rebecca, F. Satler, Lowell, Pichard, Augusto D., Bernardo, Nelson L., Waksman, Ron
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-07-2012
• Subjects: Aged; Aged, 80 and over; angioplasty; Angioplasty, Balloon, Coronary - adverse effects; Angioplasty, Balloon, Coronary - mortality; bleeding; Chi-Square Distribution; District of Columbia; Erythrocyte Transfusion; Female; Hemodynamics; Hemorrhage - diagnostic imaging; Hemorrhage - etiology; Hemorrhage - mortality; Hemorrhage - physiopathology; Hemorrhage - therapy; Hospital Mortality; Humans; Hypotension - diagnostic imaging; Hypotension - etiology; Hypotension - therapy; Logistic Models; Male; Middle Aged; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - etiology; Myocardial Infarction - therapy; non-contrasted computed tomography; Platelet Aggregation Inhibitors - adverse effects; Predictive Value of Tests; Prognosis; Radiography, Abdominal - methods; Retroperitoneal Space - diagnostic imaging; Retrospective Studies; Risk Assessment; Risk Factors; Shock, Hemorrhagic - diagnostic imaging; Shock, Hemorrhagic - etiology; Shock, Hemorrhagic - therapy; Stroke - diagnostic imaging; Stroke - etiology; Stroke - therapy; Time Factors; Tomography, X-Ray Computed
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.23200

Background: Retroperitoneal hemorrhage (RPH) is a serious but infrequent complication of percutaneous coronary intervention (PCI). This study aimed to describe the clinical outcomes of patients who developed RPH following PCI in the current practice era, with particular focus on treatment strategies and the related prognostic value of abdominal/pelvic computed tomography (CT). Methods: Among 20,904 patients undergoing PCI, we identified 93 RPH (0.45%) confirmed by CT or by unequivocal surgical findings. We identified three groups with RPH for comparison: patients who developed refractory shock (systolic blood pressure <80 mm Hg for ≥30 min despite fluids and vasopressors, n = 16 [17.2%]); patients with transient hypotension (<30 min, n = 34 [36.6%]); and patients without hypotension (n = 43 [46.2%]). The primary endpoint was a composite of in‐hospital mortality, myocardial infarction, and cerebral vascular accident (CVA). Results: Baseline clinical, angiographic, and procedural characteristics were similar among the three groups. Patients who developed refractory shock had significantly more bleeding quantified by abdominal/pelvic CT (P < 0.001), had a higher rate and amount of red blood cell transfusion (P < 0.001), and were managed invasively more frequently (68.7%) than the rest of the population. The primary endpoint trended higher in patients presenting with refractory shock; however, this difference was not statistically significant. The volume of bleeding quantified by CT and the timing of imaging diagnosis did not correlate with the primary endpoint. Red blood cell transfusion, but not clopidogrel discontinuation, was associated with the primary endpoint. Conclusions: RPH remains as a serious complication of PCI and is associated with high rates of mortality and morbidity independently of the therapeutic strategy. In patients who were hemodynamically stable, RPH volume as quantified by non‐contrast abdominal/pelvic CT did not contribute to prognosis. © 2011 Wiley Periodicals, Inc.