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Predictors of bleeding risk and long-term mortality in patients with acute coronary syndromes
1Cardiac Catheterization Laboratory, Newark Beth Israel Center, Newark, NJ 07112, USA. marcohen@sbhcs.com
Insights
Bleeding in acute coronary syndrome (ACS) patients impacts short-term mortality but is not a predictor of long-term mortality. Anticoagulant therapy may mitigate short-term bleeding risks for long-term outcomes.
Area of Science:
- Cardiology
- Clinical Medicine
- Evidence Synthesis
Background:
- Acute coronary syndrome (ACS) is a critical condition requiring careful management.
- Predictors of bleeding and mortality in ACS patients are crucial for risk stratification.
- The relationship between bleeding events and long-term mortality in ACS remains an area of investigation.
Purpose of the Study:
- To review and synthesize evidence on independent predictors of bleeding and late mortality in ACS patients.
- To compare risk factors for bleeding versus late mortality.
- To determine if bleeding is a reported predictor of late mortality in ACS.
Main Methods:
- Systematic review of computerized searches (MEDLINE, EMBASE, Cochrane Library) from 1999 to July 2004.
- Inclusion criteria: studies on ACS patients assessing risk factors for bleeding, mortality, or both.
- Exclusion criteria: studies not meeting defined criteria; 937 studies retrieved, 912 excluded.
Main Results:
- Bleeding significantly associated with mortality was confined to in-hospital or 30-day outcomes.
- Long-term mortality studies consistently found bleeding not to be an independent predictor.
- Adverse short-term outcomes (in-hospital/first month) did not correlate with 1-year mortality.
Conclusions:
- The impact of bleeding on mortality in ACS patients appears limited to the short term.
- Long-term outcomes in ACS patients do not seem to be influenced by in-hospital bleeding events.
- Beneficial effects of anticoagulant therapy may outweigh short-term bleeding risks in ACS.
Objective:
The aim of this review was to collate the published evidence on independent predictors of bleeding and late mortality in acute coronary syndrome (ACS) patients, to compare the two sets of risk factors, and to investigate whether bleeding is reported as a predictor of late mortality.
Research Design And Methods:
Computerized searches, covering the period from 1999 to July 2004, were performed on MEDLINE, EMBASE, and the Cochrane Library database. Studies were eligible for inclusion in the review if they related to patients with ACS and included an assessment of risk factors for bleeding, mortality, or both. Studies that did not meet these criteria were excluded.
Main Outcome Measures:
A total of 937 studies were retrieved, of which 912 were excluded from the review because they did not meet the defined criteria.
Results:
The available evidence suggests that any impact of bleeding on mortality is confined to the short term. In studies that showed a significant association between bleeding and risk of mortality, association between bleeding and risk of mortality, this was always related to in-hospital or 30-day mortality. By contrast, studies of long-term mortality consistently showed that bleeding was not an independent predictor. Furthermore, follow-up studies showed that adverse outcomes in hospital and within the first month were not related to 1-year mortality. This may reflect the beneficial impact of anticoagulant therapy on subsequent cardiovascular risk in patients with ACS, which outweighs any shortterm detrimental effect of bleeding.
Conclusions:
The available evidence suggests that any impact of bleeding on mortality in ACS patients appears to be confined to the short term, and long-term outcomes do not reflect the impact of in-hospital bleeding.
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