The bleeding event risk estimate received should be used to inform the overall conversation about the risks/benefits of a CathPCI procedure. It should not be used to determine the need for or against this or any medical procedure.x

Calculate Risk
*All parameters are required to derive the adjusted CathPCI bleeding event risk.

Patient Demographics

Years

Patient Pre-Procedural Characteristics  Reset

Body Mass Index (BMI) kg/m2
Enter the BMI value manually
Feet
Inches
lbs kgs
g/dL g/L

Predicted Risk

Adjusted CathPCI Bleeding Event Risk

Patient's Risk
%
National Average
3.3%
as of August, 2016
In the United States, the average bleeding event risk for all patients undergoing this procedure is 3.3%.
Taking into account the patient’s specific clinical condition, the statistical estimate that the patient may experience a bleeding event is 4%.
This means that for every 100 patients having a similar clinical makeup, there would be that experienced a bleeding event.

Bleeding Event is an absolute drop in hemoglobin ≥ , a RBC transfusion and/or a procedural intervention/surgery to reverse/stop bleeding that occurs within 72 hours of the PCI procedure.

The model provides an objective risk-adjusted estimate of bleeding which has real value for both patient and provider. It should be considered as one element in the evaluation process, to be considered along with the other traditional factors that determine whether the patient is an appropriate candidate for the procedure.

Based on following evaluation

Patient Demographics

Age :  Years
Sex : {}
Race : {}

Patient Pre-Procedural Characteristics

Body Mass Index (BMI) # kg/m2
Height
Feet  Inches
cms
Weight lbs kgs
Baseline Hemoglobin g/dL g/L
Prior STEMI Yes No
Prior Cardiogenic Shock Yes No
Prior PCI Yes No
Dialysis Yes No
Glomerular Filtration Rate (estimated) N/A mL/min/1.73m2
Serum Creatinine (SCr) mg/dL µmol/L

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Health Outcomes Sciences

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Resources

In-hospital Bleeding Rates Overall and in Pre-specified Subgroups in the Development and Validation Samples

Group Overall
(N = 1,043,759)
Development
(n = 834,696)
Validation
(n = 209,063)
All patients 5.8 5.8 5.8
STEMI 14.1 14.2 14.0
Females 8.6 8.7 8.5
Age >70 yrs 7.5 7.5 7.5
Diabetes 5.9 6.0 5.9
Excluding in-hospital CABG 5.4 5.4 5.4
Values are %.
Abbreviations as in Table 1.

Hospital Characteristics

Low
(n = 452 Sites)
Middle
(n = 453 Sites)
High
(n = 453 Sites)
Number of beds 411 (400–591) 400 (258–586) 386 (261–546)
Location
Urban 58.3 58.0 56.7
Suburban30.8 28.4 31.4
Rural 10.9 13.6 11.9
Affiliation
Government0.3 1.1 1.6
Private/community88.1 88.1 85.7
University 11.5 10.8 12.7
Average annual PCI volume 722 (433–1,198)682 (432–1,096)679 (406–1,108)
Training program 52.7 46.3 51.3
Values are median (interquartile range) or %. All p < 0.001.
PCI = percutaneous coronary intervention.

Impact of Risk Adjustment and Various Bleeding Avoidance Strategies on Variation on Bleeding Rates

Model Variance of
Hospital Effect
(95% CI)
PCV vs.
Model 1
PCV vs.
Model 2
1.Unadjusted 0.22 (0.20–0.24)
2. Patient risk
adjusted
0.17 (0.16–0.19) 19.94
3.Adjusted + radial 0.17 (0.16–0.19) 20.95 1.26
4.Adjusted +
bivalirudin
0.16 (0.15–0.18) 24.62 5.85
5.Adjusted + VCD 0.17 (0.16–0.19) 20.64 0.88
6.Adjusted + radial
+ bivalirudin
0.16 (0.15–0.17) 26.14 7.75
7.Adjusted + bivalirudin + VCD 0.16 (0.15–0.18) 24.58 5.80
8.Adjusted + radial + bivalirudin
+ VCD
0.16 (0.15–0.18) 25.63 7.11
CI = confidence interval; PCV = percentage of the proportional change in variance; VCD = vascular closure device.

Study Population Characteristics

Figure 1
Study population characteristics, including exclusions. CABG = coronary artery bypass grafting; PCI = percutaneous coronary intervention.

Distribution of Hospital-Level Post-Percutaneous Coronary Intervention Bleeding Rates Across Hospitals

Figure 2
Distribution of post–percutaneous coronary intervention bleeding, both the (A) observed rates and (B) accounting for patient-level risk adjustment using the CathPCI bleeding risk model.

Observed Use of Bleeding Avoidance Strategies



Percentage of patients (pts) receiving any bleeding avoidance strategy (BAS) by hospital and the risk-adjusted bleeding rate.

Adjusted Spline Plot for Percentage of Bleeding Avoidance Strategy Use on Bleeding Rates



Adjusted spline plot predicting rates of bleeding by percentage of bleeding avoidance strategies (BAS) used. The vertical lines represent the spline knots at the 5th, 35th, 65th, and 95th percentiles of % any BAS.

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