Log in to MyACC
Trends in Bleeding Events in Acute MI
Study Questions:
What are the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population?
Methods:
The investigators selected and evaluated patients with acute MI (n = 371,431) enrolled in the SWEDEHEART registry from 1995 until May 2018 for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding was defined as fatal, intracranial, or bleeding requiring blood transfusion or intervention. To standardize the risk of bleeding, logistic regression models were created using the imputed data with in-hospital and out-of-hospital bleeding as outcome and 2-year block as categorical predictor together with a number of possible confounders.
Results:
In-hospital bleeding increased from 0.5% to a peak at 2% in 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5% in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-of-hospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%.
Conclusions:
The authors concluded that during the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitantly there has been a substantial greater reduction of ischemic events including improved survival.
Perspective:
This registry study reports that during the study period, bleeding events doubled, with an absolute increase of in-hospital bleeding around 1% and an absolute increase of out-of-hospital bleeding around 2.3%. However, simultaneously, the rate of out-of-hospital cardiovascular death, MI, or stroke decreased by 9.3%. Thus, although the introduction of more invasive and more intense antithrombotic treatment in patients with acute MI was associated with more bleeding, there was a substantial greater reduction of ischemic events including improved survival. There is a need for additional development of the invasive and antithrombotic treatments for acute MI that will maintain the protection against ischemic events while simultaneously reducing the risk of bleeding events, thereby further improving outcomes and survival.
Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Prevention, Anticoagulation Management and ACS
Keywords: Acute Coronary Syndrome, Anticoagulants, Blood Transfusion, Cardiology Interventions, Fibrinolytic Agents, Hemorrhage, Hospitalization, Myocardial Infarction, Myocardial Ischemia, Platelet Aggregation Inhibitors, Primary Prevention, Stroke, Vascular Diseases
< Back to Listings
