Related Experiment Video
Updated: Dec 15, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI
Guillaume Marquis-Gravel1, Frederik Dalgaard2, Aaron D Jones2
1Duke Clinical Research Institute, Durham, North Carolina. Electronic address: https://twitter.com/G_MarquisGravel.
Insights
Post-discharge bleeding after acute coronary syndrome (ACS) significantly increases mortality risk, regardless of percutaneous coronary intervention (PCI) treatment. This bleeding risk is comparable to that of myocardial infarction (MI).
Area of Science:
- Cardiology
- Clinical Medicine
- Outcomes Research
Background:
- Long-term prognostic impact of post-discharge bleeding in acute coronary syndrome (ACS) patients without percutaneous coronary intervention (PCI) is understudied.
- Understanding bleeding complications is crucial for managing ACS patients, particularly those not undergoing invasive procedures.
Purpose of the Study:
- To evaluate the association between post-discharge bleeding and subsequent mortality in ACS patients.
- To compare this association based on index treatment strategy (PCI vs. no PCI).
- To contrast the prognostic impact of bleeding with that of post-discharge myocardial infarction (MI).
Main Methods:
- Harmonized data from 4 multicenter randomized trials (APPRAISE-2, PLATO, TRACER, TRILOGY ACS) were analyzed.
- Time-updated Cox proportional hazards analysis assessed the link between post-discharge bleeding (GUSTO moderate/severe/life-threatening) and all-cause mortality.
- Interaction with index treatment strategy and comparison with MI risk were performed.
Main Results:
- Among 45,011 participants, post-discharge bleeding (2.6 events/100 patient-years) was linked to significantly higher mortality risk.
- Increased mortality risk was observed both <30 days (aHR: 15.7) and 30 days to 12 months (aHR: 2.7) post-bleeding.
- This association was consistent across PCI and no-PCI groups and mirrored the risk associated with post-discharge MI.
Conclusions:
- Post-discharge bleeding following ACS carries a significant and similar increased risk of subsequent all-cause mortality, irrespective of PCI treatment.
- The prognostic impact of post-discharge bleeding is equivalent to that of post-discharge myocardial infarction.
- These findings highlight bleeding as a critical adverse event impacting long-term outcomes in ACS patients.
Background:
The long-term prognostic impact of post-discharge bleeding in the unique population of patients with acute coronary syndrome (ACS) treated without percutaneous coronary intervention (PCI) remains unexplored.
Objectives:
The aim of this study was to assess the association between post-discharge bleeding and subsequent mortality after ACS according to index strategy (PCI or no PCI) and to contrast with the association between post-discharge myocardial infarction (MI) and subsequent mortality.
Methods:
In a harmonized dataset of 4 multicenter randomized trials (APPRAISE-2 [Apixaban for Prevention of Acute Ischemic Events-2], PLATO [Study of Platelet Inhibition and Patient Outcomes], TRACER [Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome], and TRILOGY ACS [Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes]), the association between post-discharge noncoronary artery bypass graft-related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate, severe, or life-threatening bleeding (landmark 7 days post-ACS) and subsequent all-cause mortality was evaluated in a time-updated Cox proportional hazards analysis. Interaction with index treatment strategy was assessed. Results were contrasted with risk for mortality following post-discharge MI.
Results:
Among 45,011 participants, 1,133 experienced post-discharge bleeding events (2.6 per 100 patient-years), and 2,149 died during follow-up. The risk for mortality was significantly higher <30 days (adjusted hazard ratio: 15.7; 95% confidence interval: 12.3 to 20.0) and 30 days to 12 months (adjusted hazard ratio: 2.7; 95% confidence interval: 2.1 to 3.4) after bleeding, and this association was consistent in participants treated with or without PCI for their index ACS (p for interaction = 0.240). The time-related association between post-discharge bleeding and mortality was similar to the association between MI and subsequent mortality in participants treated with and without PCI (p for interaction = 0.696).
Conclusions:
Post-discharge bleeding after ACS is associated with a similar increase in subsequent all-cause mortality in participants treated with or without PCI and has an equivalent prognostic impact as post-discharge MI.
More Related Videos
10:03Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Coronary Artery Disease V: Interprofessional Care