High Bleeding Incidence in Unselected Hospitalized Suspected Non-ST-Segment Elevation Myocardial Infarction Patients
Henri Kesti1, Henna Mäkinen2, Kalle Mattila3
1Faculty of Medicine, University of Turku, 20520 Turku, Finland; Heart Centre, Turku University Hospital and University of Turku, 20521 Turku, Finland.
Insights
Bleeding events are common in acute coronary syndrome (ACS) patients, even those not selected for invasive procedures. Younger patients (<65 years) without dual antiplatelet therapy (DAPT) experienced the highest major bleeding rates.
Area of Science:
- Cardiology
- Clinical Research
- Patient Outcomes
Background:
- High bleeding risk (HBR) is frequent in acute coronary syndrome (ACS).
- Existing bleeding event data often comes from percutaneous coronary intervention registries, potentially excluding high-risk patients.
- This may lead to an underestimation of bleeding incidence in unselected ACS populations.
Purpose of the Study:
- To investigate bleeding incidence in unselected patients hospitalized with suspected non-ST-segment elevation myocardial infarction (NSTEMI).
- To assess bleeding risk factors, including dual antiplatelet therapy (DAPT) use and Academic Research Consortium for High Bleeding Risk (ARC-HBR) status.
Main Methods:
- Retrospective analysis of 209 consecutive hospitalized adult patients with suspected NSTEMI.
- Data collection via database search and electronic patient records.
- Bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria over 1-year follow-up.
Main Results:
- Overall bleeding incidence was 7.2% (15/209 patients).
- Dual antiplatelet therapy (DAPT) users had higher bleeding rates (10.7%) than non-users (3.1%, p=0.033).
- Major bleeding (BARC type 3) was most frequent in patients <65 years without DAPT.
Conclusions:
- Unselected suspected NSTEMI patients, particularly those <65 years and not on DAPT, exhibit a high bleeding incidence.
- Bleeding risk assessment in ACS should consider factors beyond traditional HBR definitions and DAPT status.
- Further research is needed to optimize bleeding prevention strategies in diverse ACS patient groups.
Abstract:
High bleeding risk (HBR) is commonly encountered among patients with acute coronary syndrome (ACS), and bleeding complications are associated with worse prognosis. Data on bleeding events of patients with ACS are based almost exclusively on percutaneous coronary intervention registries. Enrolling only patients suitable for invasive procedures might have skewed the observed bleeding incidence. We sought to investigate bleeding incidence in unselected patients with ACS. Patients were retrospectively enrolled between January and June 2019 from the emergency department of a tertiary hospital. All consecutive hospitalized adults with suspected non-ST-segment elevation myocardial infarction were included. Data was gathered by a database search and verified using electronic patient records. Bleeding risk was assessed according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) definition. The primary end point was a composite of post- discharge Bleeding Academic Research Consortium type 2, 3, and 5 bleeding during 1-year follow-up. Of the 209 included patients, 15 (7.2%) suffered a bleeding event. There were more bleeding events among dual antiplatelet therapy (DAPT) users as compared with those without DAPT (10.7% vs 3.1%, p = 0.033). Among HBR patients, 6.1% and in non-HBR patients 8.1% suffered a bleeding event (p = 0.579). Notably, major bleeding (Bleeding Academic Research Consortium type 3) incidence was highest in patients <65 years and without DAPT use. In conclusion, unselected suspected non-ST-segment elevation myocardial infarction patients aged <65 years had surprisingly high bleeding incidence, regardless of ARC-HBR status or DAPT use.
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