Higher Risk of Bleeding in Asians Presenting With ST-Segment Elevation Myocardial Infarction: Analysis of the
Naoki Misumida1, Gbolahan O Ogunbayo1, Sun Moon Kim1
11 Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA.
Insights
Asian patients with ST-segment elevation myocardial infarction (STEMI) experienced higher rates of major bleeding. This finding suggests a need for tailored treatment strategies to improve outcomes for this demographic.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Health Disparities
Background:
- Bleeding is a significant complication for ST-segment elevation myocardial infarction (STEMI) patients.
- Previous research indicates potential increased bleeding risk in Asian populations on antithrombotic therapies.
Purpose of the Study:
- To investigate the association between Asian ethnicity and inhospital major bleeding events in STEMI patients.
- To compare clinical outcomes between Asian and white STEMI patients.
Main Methods:
- Analysis of the Nationwide Inpatient Sample database (2002-2013).
- Inclusion of patients with a primary STEMI diagnosis.
- Comparison of inhospital major bleeding rates and mortality between Asian and white ethnic groups.
Main Results:
- Asian patients (n=46,563) exhibited a higher incidence of inhospital major bleeding (3.6%) compared to white patients (n=1,695,680) (2.2%, P < .001).
- Asian ethnicity was identified as an independent predictor of major bleeding (OR: 1.32; 95% CI: 1.16-1.51; P < .001).
- No significant difference in inhospital mortality was observed between ethnic groups (9.3% vs 8.7%, P = .06).
Conclusions:
- STEMI patients of Asian ethnicity face an elevated risk of major bleeding.
- Further research is needed to develop optimized, ethnicity-specific treatment strategies for STEMI management.
Abstract:
Bleeding is a major complication in patients presenting with ST-segment elevation myocardial infarction (STEMI). Several studies suggested that Asians are more susceptible to bleeding when treated with antiplatelets, anticoagulants, and thrombolytic agents. In our study, we aimed to investigate the association between Asian ethnicity and bleeding events in patients who presented with STEMI. We analyzed the Nationwide Inpatient Sample database from 2002 to 2013 and identified patients hospitalized with a primary diagnosis of STEMI. We compared clinical outcomes between patients of Asian and white ethnicity. Primary outcome was inhospital major bleeding defined as a composite of intracranial hemorrhage and blood transfusions for bleeding events. After exclusions, an estimated 1 695 680 white and 46 563 Asian patients with STEMI were included in the analysis. Asian patients had a higher incidence of inhospital major bleeding (3.6% vs 2.2%, P < .001) without a significant difference in inhospital mortality (9.3% vs 8.7%, P = .06). Asian ethnicity was an independent predictor for major bleeding (estimated odds ratio: 1.32; 95% confidence interval: 1.16-1.51; P < .001). This increased risk of bleeding would warrant further investigation of optimal treatment strategies tailored for patients with STEMI of Asian ethnicity.
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