Comparison of Bleeding Complications Using Arterial Closure Device Versus Manual Compression by Propensity Matching in Patients Undergoing Percutaneous Coronary Intervention

• Published in: The American journal of cardiology Vol. 107; no. 11; pp. 1619 - 1623
• Main Authors: Allen, Drew S., DO, Marso, Steven P., MD, Lindsey, Jason B., MD, Kennedy, Kevin F., MS, Safley, David M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-2011; Elsevier; Elsevier Limited
• Subjects: Aged; Aneurysm, False - etiology; Angioplasty, Balloon, Coronary - adverse effects; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Collagen; Comparative analysis; Diseases of the cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Equipment and Supplies; Female; Hemoglobin; Hemorrhage; Humans; Intervention; Length of Stay; Male; Medical sciences; Middle Aged; Postoperative Hemorrhage - etiology; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk assessment; Human; Atherectomy; Closure; Angioplasty; Device; Coronary artery; Manuals; Instrumentation therapy; Cardiovascular disease; Patient; Hemorrhage; Stent; Percutaneous route; Arterial disease; Vascular disease; Artery compression; Complication; Circulatory system; Cardiology; Comparative study
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.01.049

Arterial closure devices (ACDs) provide immediate hemostasis, improve comfort, and allow early ambulation after percutaneous coronary intervention (PCI). The aim of this study was to evaluate ACD utilization and post-PCI major bleeding in an unselected cohort. Patients receiving ACDs were propensity matched to those with manual compression to evaluate a primary end point of National Cardiovascular Data Registry (NCDR) major bleeding and a secondary end point of major bleeding stratified by previously developed NCDR bleeding risk categories. Bleeding events that required transfusion, prolonged hospital stays, and/or decreases in hemoglobin ≥3.0 g/dl were included. Length of stay, defined as days after PCI until discharge, was also evaluated. Secondary analysis of bleeding and complication rates between ACD types (suture vs collagen plug) was performed. Five thousand four hundred twenty-one patients underwent PCI, and 2,324 patients (43%) were included in the final propensity matching: 1,162 with ACDs and 1,162 manual compression patients. Major bleeding was reduced in ACD patients compared to those with manual compression (2.4% vs 5.2%, p <0.001), and NCDR high-risk patients receiving ACDs had the greatest reduction in major bleeds (3.1% vs 10.3%, p <0.001). Length of stay (1.9 ± 1.9 vs 2.3 ± 5.3 days, p = 0.007) and pseudoaneurysms (0.3% vs 1.1%, p = 0.028) were decreased in ACD patients. Suture-based devices revealed a lower composite event rate than collagen-plug ACDs (1.4% vs 3.4%, p = 0.048). In conclusion, ACD use is associated with reductions in NCDR major bleeding, length of stay, and pseudoaneurysms in PCI patients.