Acute cardiac care & resuscitationCohort study
Predictors of Bleeding After Percutaneous Left Ventricular Assist Device Support
- nationwide Japanese registry
Authors' conclusion
Bleeding after pLVAD support is common and occurs early, with comparable incidence across ACS and non-ACS strata. Additional MCS use is the dominant determinant of bleeding risk. ML-based phenotyping provides complementary insights into heterogeneous bleeding mechanisms.
Study context
- Population
- Patients with percutaneous left ventricular assist device (percutaneous left ventricular assist devices (pLVAD)) support, stratified into acute coronary syndrome (ACS) and non-ACS stratapatients with complete follow-up · ACS 2,667 · non-ACS 2,941
- Participants
- 5,608 patients
- Exposure
- ACS vs non-ACS
- ACSn = 2,667
- non-ACSn = 2,941
- Outcome
- Any bleeding
- Follow-up
- Within 30 days
Main finding
As reported in the abstract
P = 0.951
Observational data: associations, not effects.
Further findings
Additional mechanical circulatory support (MCS) as factor associated with bleeding
- ACS: adjusted HR
- 1.60
- non-ACS: adjusted HR
- 1.75
- both P
- P < 0.001
- strongest factor associated with bleeding in both strata
Competing-risk analyses accounting for early mortality (Fine-Gray)
- ACS: subdistribution HR
- 1.52
- non-ACS: subdistribution HR
- 1.74
- sensitivity analysis; consistent results
Machine learning analyses
- Additional MCS use identified as the dominant contributor to bleeding
- Shapley Additive exPlanations-based clustering suggested 2 high-risk phenotypes characterized by procedural complexity including additional MCS use and inflammatory-hemodynamic instability
Original publication
Predictors of Bleeding After Percutaneous Left Ventricular Assist Device Support. JACC Adv. doi:10.1016/j.jacadv.2026.103131
Summarised from the published abstract; every number is checked against it