Time is of the essence when a patient enters the hospital with a heart attack and the health care team makes decisions to administer the best possible treatment. In the case of patients with ST-elevation myocardial infarction (STEMI) — one of the most dangerous and potentially deadly forms of heart attack — the coronary artery is completely blocked, restricting life-giving blood from flowing through the arteries to the heart muscle.
Patients with STEMI are often treated with an emergency procedure called primary percutaneous coronary intervention (pPCI) to open up the blockage. This is a non-surgical approach in which clinicians thread a flexible, long and hollow tube through an artery in the patient's groin or arm.
A leading potential negative consequence of pPCI is major bleeding which may lead to blood transfusions and/or other urgent procedures to stop blood loss and replenish depleted blood stores.
Access-site major bleeding can occur at the incision point for the balloon-mounted tube. Non-access-site major bleeding can be located anywhere else in a patient's body. This is largely due to either medications used during treatment or other factors, such as comorbidities, a patients' age and a drop in hemoglobin.
Non-access-site major bleeding shown to be the greater risk factor
Dr. Wong's research study, published in CJC Open, the journal of the Canadian Cardiovascular Society, examined in-hospital access-site and non-access-site major bleeding among 1,494 STEMI patients who received pPCI between 2012 and 2018.
He found that 121 patients (8.1 per cent) experienced major bleeding. Among these, 87 had major bleeding away from the incision site and 34 experienced it where the stent tube was inserted. While 23 patients passed away as a result of non-access-site major bleeding, only two passed away from access-site major bleeding.
Similarly, cardiac arrest — when the heart stops beating after not receiving oxygenated blood for a prolonged period of time — was more associated with non-access-site major bleeding than access-site major bleeding (23 patients versus one) and stroke (12 patients versus one).
“Our findings are a clear indicator that non-access-site bleeding produced worse in-hospital outcomes, which could mean that we need to develop new approaches to prevent these bleeds."
Learn more about Dr. Wong's study on vchri.ca.
Dr. Graham Wong is the medical director for the Vancouver Coastal Health Authority/Providence Health Care STEMI Program. He is a clinical professor in the Department of Medicine at the University of British Columbia and a member of the Centre for Cardiovascular Innovation. He is also the associate director of the Coronary Care Unit at Vancouver General Hospital and the program director for the UBC Adult Cardiology Training Program.
This story was submitted by the Vancouver Coastal Health Research Institute (VCHRI).