Key result
Major bleeding is linked to a similar increase in mortality risk as MI.
Why the study?
Bleeding is a frequent and principal safety concern in patients with CAD receiving antithrombotic therapy, but its prognostic impact on mortality compared with myocardial infarction is unclear.
Does the occurrence of bleeding have a similar prognostic impact on mortality compared to myocardial infarction in patients with coronary artery disease?
Meta-Analysis (n=141,059)
Does the occurrence of bleeding have a similar prognostic impact on mortality compared to myocardial infarction in patients with coronary artery disease?
Hazard Ratio: 1.1 (95% CI 0.71–1.71)
p-value: p=0.668
Major and late bleeding are prognostically equivalent to MI regarding mortality risk in CAD patients, while early bleeding may have an even stronger association with mortality, highlighting the critical need for bleeding avoidance strategies during PCI.
Supports bleeding avoidance strategies in CAD patients undergoing PCI; extends evidence equating major bleeding's mortality risk to MI.
Background Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD). Aims We aim to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD. Methods We searched Medline and Embase for studies that included patients with CAD and that reported both, the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratio of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularization or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularization or ACS. Results 141,059 patients were included across 16 studies and 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding increased the risk of mortality to the same extent of MI (ratioHR bleedingvsMI 1.10, 95% CI, 0.71–1.71, P=0.668). Early bleeding was associated with a higher risk of mortality than early MI (ratioHR bleedingvsMI 1.46, 95% CI, 1.13–1.89, P=0.004), although this finding was not present when only randomized trials were included. Late bleeding was prognostically comparable to late MI (ratioHR bleedingvsMI 1.14, 95% CI, 0.87–1.49, P=0.358). Conclusions Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality. Impact on daily practice. Major and late bleeding should be considered prognostically equivalent to MI, given the similar association with mortality. Early bleeding has even a stronger association with mortality than early MI, emphasizing the importance of bleeding avoidance strategies among patients undergoing PCI. Funding Acknowledgement Type of funding sources: None. Visual AbstractBleeding vs MI risk of mortality
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Oliva et al. (2021) conducted a meta-analysis in Coronary artery disease (CAD) (n=141,059). Major bleeding vs. Myocardial infarction (MI) was evaluated on Mortality (ratio of HRs 1.10, 95% CI 0.71-1.71, p=0.668). Major bleeding was associated with a similar increase in the risk of mortality compared to myocardial infarction (ratio of HRs 1.10; 95% CI 0.71-1.71; P=0.668).
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