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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by
Golnaz Sadjadieh1, Thomas Engstrøm1, Steffen Helqvist1
1Department of Cardiology, Rigshospitalet-Copenhagen University Hospital, Denmark.
Insights
Serious bleeding events (TIMI minor/major bleeding) after ST-segment elevation myocardial infarction treatment are uncommon but linked to short-term mortality. Survival from bleeding does not impact long-term prognosis.
Area of Science:
- Cardiology
- Clinical Research
- Patient Outcomes
Background:
- Bleeding complications following ST-segment elevation myocardial infarction (STEMI) treatment are a known risk factor for mortality.
- Primary percutaneous coronary intervention (PCI) is a standard STEMI treatment, but carries bleeding risks.
Purpose of the Study:
- To investigate the incidence, prognosis, and associated variables of serious bleeding events within 30 days after primary PCI in STEMI patients.
- To determine the impact of these bleeding events on short- and long-term mortality.
Main Methods:
- Analysis of data from the Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) cohort (n=2,217).
- Assessment of bleeding events using Thrombolysis in Myocardial Infarction (TIMI) and Bleeding Academic Research Consortium (BARC) criteria within 30 days post-PCI.
- Multivariable analysis to identify variables associated with TIMI minor/major bleeding (TMMB) and its impact on mortality.
Main Results:
- The incidence of TMMB within 30 days was 2.7% (59 patients).
- Variables associated with TMMB included female gender, longer symptom-to-catheterization time (>3 hours), glycoprotein IIb/IIIa inhibitor use, and elevated S-creatinine.
- TMMB was strongly associated with 30-day mortality (HR 4.8), but this association disappeared when fatal bleedings were excluded, and was not observed for mortality beyond 30 days.
Conclusions:
- Serious bleeding events (TMMB) are infrequent in contemporary STEMI patients treated with primary PCI.
- TMMB is a significant predictor of 30-day mortality, but this appears to be driven by the fatal outcomes of the bleeding itself.
- Patients surviving a serious bleeding event have similar short- and long-term prognoses as those without bleeding.
Abstract:
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.
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