Anatomy of a Bleed (in the CathPCI Registry) - 2025 Quality Summit Presentation (Non-CE)-Anatomy of a Bleed (in the CathPCI Registry)

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Video Summary

In the session "Anatomy of a Bleed in the CATH PCI Registry," Dr. Jason Wasfy, Director of Outcomes Research at Mass General Hospital Cardiology, discussed updates and insights into bleeding risk modeling post-percutaneous coronary intervention (PCI). He emphasized the pressing issue of America’s high healthcare costs not translating into better life expectancy, highlighting the critical need for quality improvement in care delivery. Dr. Wasfy explained that improving risk-adjusted quality measurement models, like those for bleeding after PCI, can help optimize clinical outcomes by guiding treatment decisions and benchmarking hospital performance.<br /><br />The updated bleeding risk model addresses prior limitations by incorporating new data, improved definitions, and guidelines including changes inspired by the 2025 ACS guidelines and recent trials like MINT on transfusion thresholds. Key model features include separate reporting cohorts excluding high-risk patients with cardiogenic shock and cardiac arrest, recognizing their unique risk profiles that affect bleeding rates. The model excludes treatment decisions—such as choice of arterial access site—from risk adjustment to avoid masking quality differences because treatment choices impact bleeding risk directly.<br /><br />Dr. Wasfy highlighted radial access adoption as a major opportunity to reduce bleeding, noting it remains underused in the US compared to Europe. He discussed how bleeding after PCI, linked to poorer outcomes including mortality, is measurable and actionable. The updated model adjusts for patient complexity without "adjusting away" provider quality, encouraging clinicians not to avoid high-risk cases.<br /><br />He also addressed common questions, such as defining bleeding events by hemoglobin drops and transfusion criteria aligned with evolving clinical evidence. Implementation of the updated model is expected by Q2 2025, aiming to enhance accurate quality benchmarking and foster provider trust to ultimately improve PCI outcomes nationwide.

Keywords

intravascular imaging

percutaneous coronary intervention

IVUS

OCT

cardiovascular care

plaque assessment

stent placement

non-invasive imaging

cardiac interventions

Bleeding risk model

PCI registry

Quality improvement

Risk-adjusted quality measurement

Radial access adoption

Cardiogenic shock exclusion

ACS 2025 guidelines

MINT transfusion thresholds

Hospital performance benchmarking