Prevalence of High Bleeding Risk among Hospitalized Suspected NSTEMI Patients
Henri Kesti1,2, Henna Mäkinen2,3, Kalle Mattila2,3
1Heart Centre, Turku University Hospital and University of Turku, 20521 Turku, Finland.
Insights
Nearly half of patients hospitalized with non-ST-segment elevation myocardial infarction (NSTEMI) have high bleeding risk (HBR). Identifying these patients is crucial as their management differs significantly from those without HBR.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Contemporary guidelines emphasize identifying patients at high bleeding risk (HBR) in acute coronary syndromes (ACS).
- The prevalence of HBR in patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI) requires further investigation.
Purpose of the Study:
- To determine the prevalence of high bleeding risk (HBR) among hospitalized patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI).
- To identify common HBR criteria in this patient population.
Main Methods:
- Retrospective enrollment of consecutive patients from January to June 2019.
- Data collection via electronic patient records and database searches.
- Application of Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.
Main Results:
- 212 patients were included; 146 (68.9%) had NSTEMI.
- High bleeding risk (HBR) was identified in 47.6% (n=101) of all patients.
- Common HBR criteria included advanced age (40.4%), chronic kidney disease (33.7%), and oral anticoagulation use (20.2%).
Conclusions:
- A significant proportion of hospitalized ACS patients, particularly those with NSTEMI, meet high bleeding risk (HBR) criteria.
- Comprehensive screening for HBR is recommended in clinical practice to tailor patient management according to current guidelines.
Abstract:
In recent years, guidelines for the management of acute coronary syndromes (ACS) have placed more emphasis on identifying patients at high bleeding risk (HBR). We set out to investigate the prevalence of HBR patients according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria in hospitalized patients with suspected non-ST-segment elevation myocardial infarction (NSTEMI). Consecutive patients were retrospectively enrolled between January and June 2019 from the emergency department (ED) of a tertiary hospital. The discharge diagnosis and baseline data were manually collected using electronic patient records and database searches. Patients with non-cardiac diagnoses were excluded. Overall, 212 patients were included in the study. A total of 146 (68.9%) patients were diagnosed with NSTEMI (Type 1), 47 (22.2%) with unstable angina pectoris (UAP) and 19 (9.0%) with "other." HBR was detected in 47.6% (n = 101) of all patients. Common criteria for HBR among ACS patients were age (40.4%), chronic kidney disease (33.7%), and the use of oral anticoagulation medicines (20.2%). In conclusion, nearly half of the patients hospitalized for ACS fulfilled HBR criteria. According to contemporary guidelines, the management of HBR patients differs from that of non-HBR patients, and thus, a more comprehensive screening for HBR may be considered in clinical practice.
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