Key result
In-hospital major bleeding after primary PCI is linked to ~2.8-fold higher 3-year mortality.
Why the study?
The effect of in-hospital major bleeding on the long-term prognosis of patients undergoing primary PCI for ST-segment elevation myocardial infarction was unknown.
Does in-hospital major bleeding increase 3-year mortality and major adverse cardiovascular events in patients undergoing primary PCI for ST-segment elevation myocardial infarction?
Cohort (n=3,345)
Does in-hospital major bleeding increase 3-year mortality and major adverse cardiovascular events in patients undergoing primary PCI for ST-segment elevation myocardial infarction?
In-hospital major bleeding after primary PCI for STEMI is independently associated with a nearly three-fold increased risk of mortality and significantly higher rates of major adverse cardiovascular events through 3 years of follow-up.
Objectives We aimed to investigate the long-term prognosis of patients with in-hospital major bleeding (IHMB). Background The effect of IHMB on the long-term prognosis of patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction is unknown. Methods Primary PCI was performed in 3,345 (92.9%) of 3,602 patients in the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction) trial; in-hospital protocol-defined non-coronary artery bypass graft-related major bleeding developed in 231 (6.9%). We examined medication use at discharge, mortality, and major adverse cardiovascular events (composite of death, reinfarction, stroke, or ischemic target vessel revascularization) at 3-year follow-up in patients with and without IHMB. Results At 3-year follow-up, patients with IHMB had higher mortality (24.6% vs. 5.4%, p < 0.0001) and major adverse cardiovascular events (40.3% vs. 20.5%, p < 0.0001). The deleterious effect of major bleeding was observed within 1 month, between 1 month and 1 year, and between 1 and 3 years. IHMB was an independent predictor of mortality (hazard ratio: 2.80; 95% confidence interval: 1.89 to 4.16, p < 0.0001) at 3-year follow up. Conclusions Patients with IHMB after primary PCI have significantly increased 3-year rates of morbidity and mortality. Further investigation is warranted to understand the mechanisms underlying this relationship and to further improve outcomes in patients with ST-segment myocardial infarction. (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction [HORIZONS-AMI]; NCT00433966).
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Suh et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (n=3,345). In-hospital major bleeding (IHMB) vs. Patients without in-hospital major bleeding was evaluated on Mortality at 3-year follow-up (HR 2.80, 95% CI 1.89-4.16, p=<0.0001). In-hospital major bleeding after primary PCI was associated with higher 3-year mortality (24.6% vs. 5.4%; HR 2.80, 95% CI 1.89-4.16, p<0.0001) and MACE (40.3% vs. 20.5%, p<0.0001).
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