Bleeding complications with acute coronary syndrome in six Middle Eastern countries

Little is known about the prevalence and prognostic implications of major bleeding complications among patients admitted with acute coronary syndrome (ACS) in the Middle East. We describe the prevalence and outcome of ACS in Middle Eastern patients with and without major bleeding complications.

The Gulf Registry of Acute Coronary Events (Gulf RACE) is a prospective, multinational registry conducted for 6 months in 2007 for patients hospitalized with the final diagnosis of ACS in 65 centres in six adjacent Middle Eastern countries. There were no exclusion criteria. A total of 8166 patients were stratified according to the development of major bleeding complications during the index admission.

Compared to patients without bleeding complications, patients with major bleeding (68 patients, 0.83%) were significantly older, and had ST-segment elevation myocardial infarction. However, there were no significant differences between the two groups with regard to sex, other cardiovascular risk factors, or use of antiplatelet and antithrombotic therapy. Patients with bleeding complications had worse in-hospital outcomes including death, congestive heart failure, cardiogenic shock, recurrent myocardial infarction, and stroke. After adjusting for baseline characteristics, major bleeding was independently associated with a more than 5-fold increase in in-hospital mortality (odds ratio 5.2, 95% confidence interval 2.8-10.1, P < 0.001).

Similar to Western studies, bleeding in the setting of ACS is a powerful and independent predictor of poor in-hospital outcomes in patients admitted with ACS in the Middle East.