Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2018;71:829-36 - Vol. 71 Num.10 DOI: 10.1016/j.rec.2018.02.008

Differential Prognostic Impact on Mortality of Myocardial Infarction Compared With Bleeding Severity in Contemporary Acute Coronary Syndrome Patients

Berenice Caneiro-Queija a, Emad Abu-Assi a,, Sergio Raposeiras-Roubín a, Sergio Manzano-Fernández b, Pedro Flores Blanco b, Ángel López-Cuenca b, Rafael Cobas-Paz a, Miriam Gómez-Molina b, José Manuel Rodríguez-Rodríguez a, Francisco Calvo-Iglesias a, Mariano Valdés-Chávarri b, Andrés Íñiguez-Romo a

a Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
b Servicio de Cardiología, Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain

Refers to

Antithrombotic Therapy in Acute Coronary Syndrome: Striking a Happy Medium
Francesco Costa, Salvatore Brugaletta
Rev Esp Cardiol. 2018;71:782-6
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Keywords

Bleeding. Acute coronary syndrome. Dual antiplatelet therapy. Mortality.

Abstract

Introduction and objectives

The impact on mortality of myocardial infarction (MI) compared with the specific degree of bleeding severity occurring after discharge in acute coronary syndrome is poorly characterized. Defining this relationship may help to achieve a favorable therapeutic risk-benefit balance.

Methods

Using Cox-based shared frailty models, we assessed the relationship between mortality and postdischarge MI and bleeding severity—graded according to Bleeding Academic Research Consortium (BARC)—in 4229 acute coronary syndrome patients undergoing in-hospital coronary arteriography between January 2012 and December 2015.

Results

Both MI (HR, 5.8; 95%CI, 3.7-9.8) and bleeding (HR, 5.1; 95%CI, 3.6-7.7) were associated with mortality. Myocardial infarction had a stronger impact on mortality than BARC type 2 and 3a bleedings: (RRr, 3.8 and 1.9; P < .05), respectively, but was equivalent to BARC type 3b (RRr, 0.9; P = .88). Mortality risk after MI was significantly lower than after BARC type 3c bleeding (RRr, 0.25; P < .001). Mortality was higher after an MI in patients on dual antiplatelet therapy (DAPT) at the time of the event (HR, 2.9; 95%CI, 1.8-4.5) than in those off-DAPT (HR, 1.5; 95%CI, 0.7-3.4). In contrast, mortality was lower after a bleeding event in patients on-DAPT (HR, 1.6; 95%CI, 1.1-2.6) than in those off-DAPT (HR, 3.2; 95%CI, 1.7-5.8).

Conclusions

The differential effect on mortality of a postdischarge MI vs bleeding largely depends on bleeding severity. The DAPT status at the time of MI or bleeding is a modifier of subsequent mortality risk.

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1885-5857/© 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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