Key result
Post-thrombolysis bleeding affects ~17% of Asian STEMI patients and is linked to higher in-hospital mortality.
Why the study?
Bleeding outcomes are crucial safety endpoints with thrombolysis, but data on its incidence, characteristics, and mortality outcomes following STEMI thrombolysis were needed in an Asian population.
What is the incidence, characteristics, and mortality impact of bleeding following STEMI thrombolysis in an Asian population?
Observational (n=941)
No
What is the incidence, characteristics, and mortality impact of bleeding following STEMI thrombolysis in an Asian population?
In an Asian STEMI population, post-thrombolysis bleeding occurs in 16.6% of patients, and major or minor TIMI bleeding is significantly associated with increased in-hospital mortality.
Bleeding after STEMI thrombolysis was associated with higher mortality in this Asian cohort; hypothesis-generating for targeted prevention trials.
BACKGROUND: Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence, characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction (STEMI) thrombolysis in an Asian population.METHODS: This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis, categorised using the Thrombolysis in Myocardial Infarction (TIMI) bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS: Data from 941 patients were analysed.A total of 156 (16.6%)STEMI patients bled post-thrombolysis.Major, minor, and minimal TIMI occurred in 7 (0.7%), 17 (1.8%), and 132 (14.0%) patients, respectively.Age 65 years (P=0.031)and Malaysian Chinese (P=0.008) were associated with a higher incidence of bleeding post-thrombolysis.Conversely, foreigners (P=0.032) and current smoker (P=0.007) were associated with a lower incidence of bleeding.Both TIMI major (P<0.001) and TIMI minor (P<0.001) were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients, except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients (P=0.027). CONCLUSION:In our Asian population, the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.
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Koh et al. (2024) conducted an observational in ST-elevation myocardial infarction (n=941). Thrombolytic therapy was evaluated on Incidence of any bleeding post-thrombolysis. Following STEMI thrombolysis in an Asian population, 16.6% of patients experienced bleeding events, with TIMI major and minor bleeding significantly associated with higher in-hospital mortality.
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