Key result
TIMI major bleeding linked to ~186% higher 6-month death or reinfarction risk in ACS.
Why the study?
Bleeding remains a significant issue affecting prognosis in patients with acute coronary syndromes despite improved outcomes and aggressive management.
What is the incidence of bleeding and its impact on 6-month outcomes in unselected patients with acute coronary syndromes in real-world practice?
Cohort (n=6,394)
Yes
What is the incidence of bleeding and its impact on 6-month outcomes in unselected patients with acute coronary syndromes in real-world practice?
Hazard Ratio: 2.86 (95% CI 1.57–5.23)
In a real-world ACS registry, major bleeding remains relatively low but is a strong independent predictor of 6-month mortality and reinfarction, highlighting the need for tailored antithrombotic strategies.
Major bleeding signals higher 6-month risk in real-world ACS; leaves open whether tailored antithrombotics improve outcomes.
BACKGROUND: Although outcomes of acute coronary syndromes (ACS) have greatly improved, bleeding is still an issue. Thus, this study aims to evaluate in-hospital management and outcomes of unselected patients with ACS focusing on antithrombotic therapies and bleeding. METHODS AND RESULTS: From 22 April 2009 to 29 December 2010, 6394 consecutive Italian patients were prospectively enrolled and followed for 6 months. Most patients (55.3%) had non-ST-elevation (NSTE) ACS. Of the ST-elevation (STE) ACS patients, 79.8% received reperfusion (mainly mechanical). In-hospital and 6-month unadjusted total mortality rates were 4.2 and 7.8% for STE-ACS and 2.5 and 6.4% for NSTE-ACS, respectively. During hospitalization, TIMI major bleeding rate was 1.2% (1.4% STE-ACS and 1.1% NSTE-ACS, respectively) and TIMI minor bleeding was 3.1%. In-hospital and 6-month unadjusted total mortality rates were 3.1 and 6.7% for patients without bleeding, 1.5 and 8.6% for minor bleeding, and 19.0 and 26.6% for TIMI major bleeding, respectively (p<0.0001). Notably, TIMI major bleeding was one of the strongest predictors of the 6-month composite end point (death or reinfarction) (STE-ACS hazard ratio, HR, 2.86, 95% confidence interval, 95% CI, 1.57-5.23; NSTE-ACS HR, 2.71, 95% CI 1.52-4.80). Predictors of in-hospital TIMI major bleeding were weight (odds ratio, OR, 0.97, 95% CI 0.95-0.99), female gender (OR 1.80, 95% CI 1.09-2.96), history of peripheral vasculopathy (OR 2.95, 95% CI 1.83-4.78), switching anticoagulant therapy (OR 2.62, 95% CI 1.36-5.05), intra-aortic balloon pump implantation (OR 4.44, 95% CI 1.85-10.69), and creatinine ≥2 mg/dl on admission (OR 3.68, 95% CI 1.84-7.33). CONCLUSIONS: Despite aggressive management, the rate of bleeding remains relatively low in an unselected ACS population. However, major bleeding adversely affects prognosis and physicians should tailor treatments to reduce it.
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Casella et al. (2013) conducted a cohort in Acute coronary syndromes (ACS) (n=6,394). TIMI major bleeding vs. No bleeding was evaluated on 6-month composite end point (death or reinfarction) in STE-ACS (HR 2.86, 95% CI 1.57-5.23). TIMI major bleeding strongly predicted the 6-month composite of death or reinfarction in both STE-ACS (HR 2.86; 95% CI 1.57-5.23) and NSTE-ACS (HR 2.71; 95% CI 1.52-4.80) patients.
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