Mortality after bleeding versus myocardial infarction in coronary artery disease: a systematic review and
Raffaele Piccolo1, Angelo Oliva, Marisa Avvedimento
1Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Insights
Bleeding and myocardial infarction (MI) carry similar mortality risks in coronary artery disease (CAD) patients. However, early bleeding events may pose a greater mortality risk than early MI.
Area of Science:
- Cardiology
- Clinical Research
- Public Health
Background:
- Bleeding is a primary safety concern in antithrombotic therapy for coronary artery disease (CAD) patients.
- Bleeding events are frequent in patients with CAD.
Purpose of the Study:
- To evaluate the prognostic impact of bleeding on mortality compared to myocardial infarction (MI) in CAD patients.
- To determine if bleeding risk is comparable to MI risk in CAD.
Main Methods:
- A meta-analysis of 16 studies including 141,059 patients with CAD was conducted.
- Adjusted hazard ratios for mortality associated with bleeding and MI were extracted and pooled.
- Early events were defined as within 30 days, while late events were beyond 30 days post-revascularization or acute coronary syndrome (ACS).
Main Results:
- Major bleeding showed a similar mortality risk to MI (rHR 1.10).
- Early bleeding was associated with a higher mortality risk than early MI (rHR 1.46), though this was not consistent in randomized trials.
- Late bleeding demonstrated a comparable mortality risk to late MI (rHR 1.14).
Conclusions:
- Major and late bleeding events are associated with a similar increase in mortality risk as MI in CAD patients.
- Early bleeding events may present a stronger association with mortality risk compared to early MI.
Background:
Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD).
Aims:
We aimed to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD.
Methods:
We searched Medline and Embase for studies that included patients with CAD and that reported both the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratios of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularisation or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularisation or ACS.
Results:
A total of 141,059 patients were included across 16 studies; 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding increased the risk of mortality to the same extent as MI (rHRsbleedingvsMI 1.10, 95% CI: 0.71-1.71, p=0.668). Early bleeding was associated with a higher risk of mortality than early MI (rHRsbleedingvsMI 1.46, 95% CI: 1.13-1.89, p=0.004), although this finding was not present when only randomised trials were included. Late bleeding was prognostically comparable to late MI (rHRsbleedingvsMI 1.14, 95% CI: 0.87-1.49, p=0.358).
Conclusions:
Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality.
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