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Article
Does comorbidity account for the excess mortality in patients with major bleeding in acute myocardial infarction
Quantitative Health Sciences Publications and Presentations
  • Frederick A. Spencer, McMaster University
  • Mauro Moscucci, University of Michigan
  • Christopher B. Granger, Duke University
  • Joel M. Gore, University of Massachusetts Medical School
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Phillippe Gabriel Steg, Centre Hospitalier Bichat-Claude Bernard
  • Shaun G. Goodman, University of Toronto
  • Andrzej Budaj, Grochowski Hospital
  • Gordon Fitzgerald, University of Massachusetts Medical School
  • Keith A. A. Fox, University of Edinburgh
UMMS Affiliation
Department of Medicine, Division of Cardiovascular Medicine; Department of Surgery
Date
11-21-2007
Document Type
Article
Medical Subject Headings
Aged; Aged, 80 and over; Anticoagulants; Female; Fibrinolytic Agents; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Patient Discharge; Proportional Hazards Models; Randomized Controlled Trials as Topic; Registries; Regression Analysis; Retrospective Studies; Risk Assessment; Survival Analysis; Treatment Outcome
Abstract
BACKGROUND: Analyses from randomized controlled trials suggest that bleeding in patients with acute myocardial infarction is associated with poor outcomes. Because these data are not generalizable to all patients with acute myocardial infarction, we sought to better understand the scope of this problem in a "real-world" setting. METHODS AND RESULTS: We examined the frequency of major bleeding in 40,087 patients with acute myocardial infarction enrolled in the Global Registry of Acute Coronary Events. Regression analyses were used to examine the association between patient and treatment characteristics, bleeding, and hospital and postdischarge outcomes. Major bleeding occurred in 2.8% of patients. These patients were older, more severely ill, and more likely to undergo invasive procedures. Patients with bleeding were more likely to die during hospitalization (hazard ratio, 1.9; 95% confidence interval, 1.6 to 2.2) but not after discharge (hazard ratio, 0.8; 95% confidence interval, 0.6 to 1.0) than patients who did not bleed. Continuation of antithrombotic therapies after day 1 was lower in patients who experienced early bleeding. Moreover, in patients who bled, hospital mortality was increased in those who discontinued aspirin, thienopyridines, or low-molecular-weight heparins. CONCLUSIONS: Major bleeding occurred in 1 in 35 patients with acute myocardial infarction; these patients accounted for approximately 10% of all hospital deaths. Nevertheless, risk of hospital mortality associated with bleeding was much lower than reported in randomized controlled trials. These data suggest that although bleeding may be causally related to adverse outcomes in some patients in the real-world setting, it is often merely a marker for patients at higher risk for adverse outcomes.
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Citation: Circulation. 2007 Dec 11;116(24):2793-801. Epub 2007 Nov 19. Link to article on publisher's site
Related Resources
Link to Article in PubMed
Citation Information
Frederick A. Spencer, Mauro Moscucci, Christopher B. Granger, Joel M. Gore, et al.. "Does comorbidity account for the excess mortality in patients with major bleeding in acute myocardial infarction" Vol. 116 Iss. 24 (2007) ISSN: 0009-7322 (Linking)
Available at: http://works.bepress.com/robert_goldberg/190/