Key result
High bleeding risk is linked to ~5.8-fold higher 1-year mortality after acute coronary syndrome.
Why the study?
High bleeding risk is associated with adverse outcomes in ACS patients, prompting an evaluation of temporal trends in treatment and outcomes according to bleeding risk.
Does high bleeding risk predict increased mortality and MACE in patients with acute coronary syndrome?
Cohort (n=13,058)
Yes
Does high bleeding risk predict increased mortality and MACE in patients with acute coronary syndrome?
Odds Ratio: 5.8 (95% CI 3.9–8.6)
Absolute Event Rate: 22.4% vs 2.1%
p-value: p=<0.001
Despite contemporary improvements in guideline-directed therapies and revascularization strategies, high bleeding risk remains a strong, independent predictor of adverse cardiovascular outcomes and mortality in patients with acute coronary syndrome.
High bleeding risk flags ACS patients for intensified monitoring; supports CRUSADE integration into prognostic models but leaves targeted interventions open.
(1) Background: High bleeding risk is associated with adverse outcomes in ACS patients. We aimed to evaluate temporal trends in treatment and outcomes of ACS patients according to bleeding risk. (2) Methods: Included were ACS patients enrolled in ACSIS surveys. Patients were divided into three groups according to enrolment period: early (2002−2004), mid (2006−2010) and recent (2012−2018). Each group was further stratified into three subgroups according to CRUSADE bleeding risk score. The primary endpoints were 30-day MACE and 1-year all-cause mortality. (3) Results: Included were 13,058 ACS patients. High bleeding risk patients were less frequently treated with guideline-based medications and coronary revascularization. They also had higher rates of 30-day MACE and 1-year all-cause mortality regardless of the enrollment period. Among patients enrolled in early period, 30-day MACE rates were 10.8%, 17.5% and 24.3% (p < 0.001) and 1-year all-cause mortality rates were 2%, 7.7% and 23.6% (p < 0.001) in the low, moderate and high bleeding risk groups, respectively. Among patients enrolled in mid period, 30-day MACE rates were 7.7%, 13.4% and 23.5% (p < 0.001) and 1-year all-cause mortality rates were 1.5%, 7.2% and 22.1% (p < 0.001) in low, moderate and high bleeding risk groups, respectively. For patients enrolled in recent period, 30-day MACE rates were 5.7%, 8.6% and 16.2%, (p < 0.001) and 1-year all-cause mortality rates were 2.1%, 6% and 22.4%, (p < 0.001) in low, moderate and high bleeding risk groups, respectively. These differences remained significant following a multivariate analysis. (4) Conclusions: The percentage of patients at high bleeding risk has decreased over the last years. Despite recent improvements in the treatment of ACS patients, high bleeding risk remains a strong predictor of adverse outcomes.
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Arow et al. (2022) conducted a cohort in Acute Coronary Syndrome (n=13,058). High bleeding risk (CRUSADE score 41-96) vs. Low bleeding risk (CRUSADE score 1-30) was evaluated on 1-year all-cause mortality (OR 5.8, 95% CI 3.9-8.6, p=<0.001). High bleeding risk was associated with significantly higher 1-year all-cause mortality compared to low bleeding risk (22.4% vs 2.1%, OR 5.8) in recent acute coronary syndrome cohorts.
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