Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

TY - JOUR

T1 - Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

AU - Sadjadieh, Golnaz

AU - Engstrøm, Thomas

AU - Helqvist, Steffen

AU - Høfsten, Dan Eik

AU - Køber, Lars

AU - Pedersen, Frants

AU - Laursen, Peter Nørkjær

AU - Nepper-Christensen, Lars

AU - Clemmensen, Peter

AU - Møller-Helgestad, Ole Kristian

AU - Sørensen, Rikke

AU - Ravkilde, Jan

AU - Terkelsen, Christian Juhl

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Tilsted, Hans-Henrik

AU - Kelbæk, Henning

AU - Holmvang, Lene

N1 - Copyright © 2018 Elsevier Inc. All rights reserved.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

AB - Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

KW - Aged

KW - Aged, 80 and over

KW - Anticoagulants/therapeutic use

KW - Antithrombins/therapeutic use

KW - Aspirin/therapeutic use

KW - Creatinine/blood

KW - Female

KW - Heparin/therapeutic use

KW - Hirudins

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Mortality

KW - Multivariate Analysis

KW - Peptide Fragments/therapeutic use

KW - Percutaneous Coronary Intervention

KW - Platelet Aggregation Inhibitors/therapeutic use

KW - Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors

KW - Postoperative Hemorrhage/epidemiology

KW - Prognosis

KW - Proportional Hazards Models

KW - Purinergic P2Y Receptor Antagonists/therapeutic use

KW - Recombinant Proteins/therapeutic use

KW - ST Elevation Myocardial Infarction/surgery

KW - Sex Factors

KW - Time-to-Treatment/statistics & numerical data

U2 - 10.1016/j.amjcard.2017.12.019

DO - 10.1016/j.amjcard.2017.12.019

M3 - SCORING: Journal article

C2 - 29402421

VL - 121

SP - 781

EP - 788

JO - AM J CARDIOL

JF - AM J CARDIOL

SN - 0002-9149

IS - 7

ER -