Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry
Why the study?
To describe time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in nationwide acute myocardial infarction patients.
Structured PICO
P
Population
Patients with acute myocardial infarction (n = 371,431) enrolled in the SWEDEHEART registry from 1995 until May 2018.
O
Outcome
In-hospital bleeding and out-of-hospital bleeding events at 1 yearsafety
The introduction of invasive and more intense antithrombotic treatments for acute MI over the last 20 years has increased bleeding events but substantially reduced ischemic events and improved survival.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The established treatment concepts have been further fine-tuned and improved, but few new treatment concepts have been introduced. These data indicate an urgent need for a better individual tailoring of more costly treatments in order to maintain cost-effectiveness and also for identification of new breakthrough treatments to further improve outcomes in AMI.”
MGMartha GulatiCardiologist, Banner-University Medicine Heart Institute
“Trying to figure out how we can make further reductions really becomes the question for our future.”
Implication
Clinicians should prioritize bleeding avoidance strategies with intensified antithrombotic therapy in MI; leaves open scope for treatments improving net clinical benefit.[[1]](https://www.acc.
Abstract
AIMS: To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population. METHODS AND RESULTS: Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-of-hospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%. CONCLUSION: During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.
Discussion
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Cite This Study
Simonsson et al. (2019) studied this question.