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The Prognostic Impact of In-Hospital Major Bleeding and Recurrence of Myocardial Infarction during Acute Phase after
Yuki Matsuoka1, Yohei Sotomi1, Shungo Hikoso1
1Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
Insights
Major bleeding within 7 days of percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) increases 30-day and 1-year mortality. Recurrent myocardial infarction (ReMI) did not significantly impact mortality in this East Asian cohort.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) patients face risks of recurrent myocardial infarction (ReMI) and bleeding events.
- The prognostic impact of these early post-AMI events on long-term mortality in East Asian populations remains unclear.
- Understanding these risks is crucial for optimizing patient management after percutaneous coronary intervention (PCI).
Purpose of the Study:
- To investigate the impact of major bleeding and ReMI within 7 days of PCI on subsequent mortality in AMI patients.
- To analyze the time-dependent changes in the prognostic significance of these early events.
- To provide insights into risk stratification and management strategies for East Asian AMI patients.
Main Methods:
- Prospective, multicenter observational study involving 6,769 eligible AMI patients undergoing PCI.
- Patients were categorized based on the occurrence of major bleeding or ReMI within 7 days of PCI.
- All-cause death was assessed as the primary endpoint up to 5 years post-PCI, with adjusted survival analyses.
Main Results:
- Major bleeding within 7 days of PCI was independently associated with increased 30-day (OR: 2.06) and 30-day to 1-year mortality (OR: 2.03).
- Recurrent myocardial infarction (ReMI) within 7 days did not show a significant association with mortality in the early or late phases.
- Neither major bleeding nor ReMI significantly impacted mortality between 1 and 5 years post-PCI.
Conclusions:
- Major bleeding occurring within the first week after PCI for AMI is a significant independent predictor of short-term (30-day and 1-year) mortality.
- Recurrent myocardial infarction (ReMI) within the first week did not significantly affect mortality outcomes in this cohort.
- Clinical focus should prioritize minimizing bleeding complications in the acute phase following PCI for AMI patients.
Aim:
Both recurrent myocardial infarction (ReMI) and bleeding events after acute myocardial infarction (AMI) were reportedly associated with increased mortality. To date, the prognostic impact of these events on subsequent outcomes in East Asians is still unclear. In this study, we aimed to investigate the impact of bleeding or thrombotic events during acute phase on subsequent mortality and time-dependent change of the impact in patients with AMI undergoing percutaneous coronary intervention (PCI).
Method:
We conducted a prospective, multicenter, observational study of patients with AMI (n=12,093). The patients who did not undergo emergent PCI were excluded. In addition, the patients registered before 2003 were excluded because the data of bleeding severity was not obtained. Eligible patients were divided into two groups based on the occurrence of major bleeding within 7 days of PCI, and the same approach was performed for ReMI within 7 days of PCI. The endpoint of this study was all-cause death. We assessed the impact of major bleeding and ReMI, which occurred within 7 days of index PCI, on the subsequent clinical outcomes up to 5 years.
Results:
A total of 6,769 patients were found to be eligible. All-cause death occurred in 898 (13.3%) patients during a median follow-up period of 1,726 [511-1,840] days. After adjustment for multiple confounders, major bleeding in 7 days from index PCI was independently associated with higher 30-day and 30-day to 1-year mortality (odds ratio [OR]: 2.06 [1.45-2.92] p＜0.001, OR: 2.03 [1.28-3.15] p=0.002), whereas ReMI was not (OR: 1.93 [0.92-3.80] p=0.07, OR: 0.81 [0.24-2.03] p=0.68). Major bleeding and ReMI did not affect mortality between 1 and 5 years (hazard ratio [HR]: 1.32 [0.77-2.26] p=0.31, HR: 0.48 [0.12-1.94] p=0.30).
Conclusion:
Major bleeding in 7 days from admission was independently associated with higher 30-day and 1-year mortality but not during 1-5 years. ReMI did not affect mortality in all phases. We should be more concerned about bleeding event during acute phase after PCI.
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