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  • 4% in 2005 to 8.1% by 2009 (Online BAY-61-3606 research buy Appendix). There was a modest ?20% temporal reduction in post-PCI bleeding overall (from 2.4% in 2005 to 2.0% in 2009) and for each group (1.4% to 1.1% in the elective PCI group, 2.3% to 1.8% in the UA/NSTEMI group, and 4.9% to 4.5% in the STEMI group) (Fig. 1). In comparison of access site versus nonaccess site bleeding, there was a significant temporal reduction in access site bleeding among all 3 groups (p <0.001) (Fig. 1). Meanwhile, the annual rate of nonaccess site bleeding remained relatively constant for elective PCI (p = 0.104) and UA/NSTEMI (p = 0.827), and increased for the STEMI group (from 2.6% to 3.1%) during the study (p < 0.001). As demonstrated by Model 1 in Table 2, there was a significant 6% to 8% per year reduction in risk of annual bleeding among the elective PCI and UA/NSTEMI groups after adjusting for clinical characteristics associated with bleeding (i.e., covariates in the CathPCI Bleeding Model). The largest relative annual reduction in risk was observed for the elective PCI group (OR: 0.919; 95% confidence interval [CI]: 0.895 to 0.945). Although there was a trend, there was not a significant temporal reduction in annual bleeding risk among the STEMI group (p = 0.088). As seen in <a href="">Q-VD-Oph research buy Figure 2, radial approach to catheterization was infrequent (<1.5% overall). Vascular closure device use was more common and increased slightly during the study by a relative 10% to 13% among all 3 groups (Fig. 3). The changes in antithrombotic strategies over time were much greater than that of vascular strategies (Fig. 4); overall, bivalirudin use increased from 17% to 30%, whereas heparin + GPI decreased from 41% to 28% during the study. This was largely driven by the adoption <a href="">Sunitinib of bivalirudin only antithrombotic strategy in the elective PCI and UA/NSTEMI groups, given that its use remained relatively low (<10%) in the STEMI group. Model 2 was developed to assess whether the temporal changes in vascular strategies could partly explain the temporal reduction in annual bleeding events during the study. As noted in Figure 5, after accounting for the vascular strategies (Model 2), there was a small, but significant, increase in the OR for time trend of annual bleeding toward the null (i.e., 1) when comparing the adjusted OR of annual bleeding estimated by Model 1 and Model 2 for the elective PCI subgroup (OR: 0.920 to 0.924; p < 0.001) and for the UA/NSTEMI subgroup (OR: 0.939 to 0.942; p = 0.015) after accounting for vascular strategies (STEMI was not reported because there was no temporal reduction in bleeding for STEMI). This <1% change in relative risk of annual bleeding suggests that the temporal increase in vascular access strategies (either radial artery access or use of vascular closure devices) was associated minimally with the temporal reduction in annual major bleeding rates. Model 3 (Fig.</div>

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