Long-term Trends in Upper Gastrointestinal Bleeding and Ischemic Outcomes after Myocardial Infarction

Invasive management and intensive antithrombotic regimens have decreased ischemic risk after myocardial infarction (MI) at the cost of more bleeding. Of particular concern is upper gastrointestinal bleeding (UGIB), which is both common and preventable, yet not well characterized over time. We aimed to describe trends of UGIB hospitalization in relation to other bleeding and ischemic outcomes as well as to explore associated clinical factors.

We included patients with acute MI enrolled in the SWEDEHEART registry discharged alive on antithrombotic treatment between 1999 and 2020. Patients were followed for hospitalization for adverse events at one year. Trends were analyzed in 2-year intervals for the overall cohort and subgroups. Standardized event rates for UGIB were calculated to assess the association of changes in demographics, comorbidities, in-hospital procedures and pharmacotherapy.

Bleeding hospitalizations increased from 2.4% to 4.5%, peaking at 4.7% in 2013-14, while one-year MACCE decreased from 20.1% to 9.4%. The gastrointestinal tract was the most common bleeding site across all time intervals, with the majority of cases being UGIBs. Percutaneous coronary intervention, dual antiplatelet therapy, potent antiplatelet agents, and direct oral anticoagulants increased over time. Standardized event rates for UGIB suggest that changes in incidence were associated with evolving management strategies.

Bleeding hospitalizations after MI increased until 2013-14, with UGIB the most common source, while ischemic outcomes declined. These opposing trends were associated with the adoption of invasive management and intensified antithrombotic therapy. Routine tailoring of antithrombotic intensity and systematic gastroprotective measures should be considered in post-MI care.