Objectives We sought to determine the relationship between the degree of left ventricular ejection fraction (LVEF) impairment and the frequency and type of bleeding events after percutaneous coronary intervention (PCI). Design This was an observational retrospective cohort analysis. Patients who underwent PCI from 2009 to 2017 were identified from our institutional National Cardiovascular Disease Registry (NCDR) CathPCI database. Patients were stratified by pre-PCI LVEF: preserved (≥50%), mildly reduced (41%–49%) and reduced (≤40%) LVEF. Primary outcome measures The outcome was major bleeding, defined by NCDR criteria. Events were classified based on bleeding aetiology and analysed by multivariable logistic regression. Results Among 13 537 PCIs, there were 817 bleeding events (6%). The rate of bleeding due to any cause, blood transfusion, gastrointestinal bleeding and coronary artery perforation or tamponade each increased in a stepwise fashion comparing preserved, mildly reduced and reduced LVEF reduction (p<0.05 for all comparisons). However, there were no differences in bleeding due to asymptomatic drops in haemoglobin, access site haematoma or retroperitoneal bleeding. After multivariable adjustment, mildly reduced and reduced LVEF remained independent predictors of bleeding events (OR 1.36, 95% CI 1.06 to 1.74, p<0.05 and OR 1.73, 95% CI 1.45 to 2.06, p<0.0001). Conclusions The degree of LV dysfunction is an independent predictor of post-PCI major bleeding events. Patients with mildly reduced or reduced LVEF are at greatest risk of post-PCI bleeding, driven by an increased need for blood transfusion, major GI bleeding events and coronary artery perforation or tamponade. Pre-PCI LV dysfunction does not predict asymptomatic declines in haemoglobin, access site haematoma or retroperitoneal bleeding. Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author, GWR, upon reasonable request.

中文翻译：

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射血分数降低的心力衰竭接受经皮冠状动脉介入治疗的患者主要出血事件的病因学和预测因素

目的 我们试图确定左心室射血分数 (LVEF) 受损程度与经皮冠状动脉介入治疗 (PCI) 后出血事件的频率和类型之间的关系。设计 这是一项观察性回顾性队列分析。 2009 年至 2017 年接受 PCI 的患者是从我们机构的国家心血管疾病登记处 (NCDR) CathPCI 数据库中确定的。根据 PCI 前 LVEF 对患者进行分层：LVEF 保留（≥50%）、轻度降低（41%–49%）和降低（≤40%）。主要结局指标 结局为大出血，由 NCDR 标准定义。根据出血病因对事件进行分类，并通过多变量逻辑回归进行分析。结果 13 537 例 PCI 中，发生出血事件 817 例（6%）。与保留、轻度降低和降低的 LVEF 降低相比，任何原因导致的出血、输血、胃肠道出血和冠状动脉穿孔或填塞均以逐步方式增加（所有比较 p<0.05）。然而，由于无症状血红蛋白下降、穿刺部位血肿或腹膜后出血而导致的出血没有差异。多变量调整后，轻度降低和降低的 LVEF 仍然是出血事件的独立预测因子（OR 1.36，95% CI 1.06 至 1.74，p<0.05；OR 1.73，95% CI 1.45 至 2.06，p<0.0001）。结论 左室功能障碍程度是 PCI 术后大出血事件的独立预测因素。由于输血需求增加、严重胃肠道出血事件以及冠状动脉穿孔或填塞，左心室射血分数轻度降低或降低的患者发生 PCI 后出血的风险最大。 PCI 前的左心室功能障碍并不能预测无症状的血红蛋白下降、通路部位血肿或腹膜后出血。数据可根据合理要求提供。支持本研究结果的数据可根据合理要求从通讯作者 GWR 处获得。