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Updated: Jan 19, 2026
Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry
Moa Simonsson1,2, Lars Wallentin3, Joakim Alfredsson4
1Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
Insights
Over 20 years, myocardial infarction (MI) treatments increased bleeding events but significantly reduced ischemic events and improved survival. This study tracked bleeding trends alongside new therapies in a nationwide MI population.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Over the past two decades, advancements in myocardial infarction (MI) treatment have involved more invasive strategies and potent antithrombotic therapies.
- These therapeutic shifts have implications for both ischemic outcomes and bleeding risks in patients.
Purpose of the Study:
- To analyze the temporal trends of in-hospital and out-of-hospital bleeding in a nationwide myocardial infarction (MI) population.
- To correlate these bleeding trends with the evolution of new treatments and changes in ischemic outcomes over a 20-year period.
Main Methods:
- A nationwide cohort of 371,431 acute myocardial infarction (MI) patients from the SWEDEHEART registry (1995-2018) was evaluated.
- In-hospital and out-of-hospital bleeding events were assessed at 1 year, alongside the utilization of invasive strategies and antithrombotic treatments, including dual antiplatelet therapy (DAPT).
Main Results:
- In-hospital bleeding rates increased from 0.5% to a peak of 2% before settling around 1.3%, while out-of-hospital bleeding rose from 2.5% to 4.8%.
- Bleeding increases paralleled the rise in invasive procedures and potent dual antiplatelet therapy (DAPT).
- Ischemic events, including re-infarction and a composite of MI, cardiovascular death, and stroke, significantly decreased during the study period.
Conclusions:
- The adoption of more intensive antithrombotic treatments in MI care has led to an increase in bleeding events.
- Despite increased bleeding, there have been substantial reductions in ischemic events and improvements in patient survival.
Aims:
To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population.
Methods And Results:
Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-of-hospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%.
Conclusion:
During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.
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