Association of bleeding, mortality and sex in acute coronary syndromes: the missing triangle
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Emilia Solinas1, Luigi Vignali, Paolo Ortolani
1aUnità Operativa di Cardiologia, Azienda Ospedaliero-Universitaria, Parma bIstituto di Cardiologia, Policlinico S. Orsola-Malpighi, Università di Bologna cAgenzia Sanitaria Regionale Regione Emilia-Romagna, Bologna dUnità Operativa di Cardiologia Interventistica, Ospedale Santa Maria Nuova, Reggio Emilia, Italy eZena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, USA fUnità Operativa Ricerca e Innovazione, Azienda Ospedaliero-Universitaria, Parma gUnità Operativa di Cardiologia, Ospedale Niguarda, Milan, Italy *Emilia Solinas and Luigi Vignali contributed equally to the writing of this article.
Insights
Women undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) experience higher in-hospital bleeding rates than men. However, bleeding, not female sex, independently predicts short-term mortality, with no significant long-term mortality difference observed.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Percutaneous coronary intervention (PCI) and antithrombotic drugs are standard treatments for acute coronary syndromes (ACS).
- The impact of these therapies on bleeding and mortality specifically in women with ACS requires further investigation.
Purpose of the Study:
- To determine if in-hospital bleeding rates after ACS are significantly higher in women compared to men.
- To evaluate the impact of in-hospital bleeding on short- and long-term mortality in ACS patients, comparing outcomes between sexes.
Main Methods:
- Prospective observational cohort study involving 1686 ACS patients (511 women, 1175 men) undergoing coronary angiography and PCI.
- Data collected from June 2010 to November 2011 across 6 centers in the REgistro regionale AngiopLastiche dell'Emilia-Romagna program.
- Statistical analysis adjusted for baseline clinical and procedural variables to compare bleeding rates and mortality outcomes between sexes.
Main Results:
- Women were older and had more comorbidities (hypertension, heart failure), but adjusted clinical and procedural variables were similar to men.
- A significantly higher rate of in-hospital bleeding was observed in women (8.6% vs. 5.8%; adjusted OR 1.73).
- Bleeding, not female sex, was an independent predictor of short-term mortality (adjusted HR 2.68), but this association was not significant for long-term mortality.
Conclusions:
- In a contemporary Italian PCI registry, women with ACS experienced higher in-hospital bleeding rates compared to men after adjustment for baseline differences.
- Female sex was not associated with worse short- or long-term mortality outcomes.
- In-hospital bleeding was confirmed as an independent predictor of short-term mortality in ACS patients.
Aims:
Percutaneous coronary intervention (PCI) and antithrombotic drugs are the standard therapy for patients with acute coronary syndromes (ACS), but their impact on bleeding and mortality in women has not been adequately investigated.
Methods:
This was a prospective observational cohort study of ACS patients, who were referred to 6 of the 13 centres belonging to the REgistro regionale AngiopLastiche dell'Emilia-Romagna programme in Emilia-Romagna for coronary angiography and PCI between June 2010 and November 2011. The aim of the study was to verify whether the incidence of Global Registry of Acute Coronary Events-defined in-hospital bleeding after an ACS is significantly higher in women than in men, and to evaluate its impact on short and long-term mortality.
Results:
The analysis involved a total of 1686 patients (511 women and 1175 men). The women were older and more frequently affected by hypertension, congestive heart failure and single-vessel disease; however, none of the clinical or procedural variables was significantly different between the sexes after statistical adjustment. There was a significantly higher rate of in-hospital bleeding among the women [8.6 vs. 5.8%; adjusted odds ratio 1.73, 95% confidence interval (CI) 1.19-2.52, P = 0.004], but the adjusted hazard ratio for short and long-term all-cause mortality was not significantly different. After optimal adjustment, bleeding, but not female sex, was identified as a predictor of short-term all-cause mortality (hazard ratio 2.68, 95% CI 1.21-5.93, P = 0.01), but this was not confirmed in the case of long-term mortality (hazard ratio 1.57, 95% CI 0.91-2.71, P = 0.10).
Conclusion:
After optimal adjustment for baseline differences, the findings of this contemporary Italian PCI registry study showed that women experience bleeding more frequently, but do not have worse mortality outcomes than men. Bleeding was confirmed as an independent predictor of short-term mortality.
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