The association of in-hospital major bleeding with short-, intermediate-, and long-term mortality among older patients with non-ST-segment elevation myocardial infarction

Renato D. Lopes, Sumeet Subherwal, Dajuanicia N. Holmes, Laine Thomas, Tracy Y. Wang, Sunil V. Rao, Erik Magnus Ohman, Matthew T. Roe, Eric D. Peterson, Karen P. Alexander

Research output: Contribution to journalArticlepeer-review

Abstract

AimsBleeding complications have been associated with short-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Their association with long-term outcomes is less clear. This study examines mortality associated with in-hospital bleeding during NSTEMI over time intervals starting from hospital discharge and extending past 3 years. Methods and resultsWe studied 32 895 NSTEMI patients aged <65 years, using patient-level data from the CRUSADE registry linked with Medicare claims data. We assessed the association of in-hospital major bleeding with short (30 days), intermediate (1 year), and long-term (3 years) mortality among hospital survivors overall, as well as in those patients treated with or without a percutaneous coronary intervention (PCI). We calculated adjusted hazard ratios (HRs) for mortality for bleeders vs. non-bleeders over time intervals from: (i) discharge to 30 days; (ii) 31 days to 1 year; (iii) 1 year to 3 years; and (iv) beyond 3 years. Overall, 11.9 (n = 3902) had an in-hospital major bleeding event. Cumulative mortality was higher in those who had a major bleed vs. those without at 30 days, 1 year, and 3 years. Even after adjustment, major bleeding continued to be significantly associated with higher mortality over time in the overall population: (i) discharge to 30 days [adjusted HR 1.33; 95 confidence interval (CI) 1.18-1.51]; (ii) 31 days to 1 year (1.19; 95 CI 1.10-1.29); (iii) 1 year to 3 years (1.09; 95 CI 1.01-1.18), and (iv) attenuating beyond 3 years (1.14; 95 CI 0.99-1.31). In-hospital bleeding among patients treated with PCI continued to be significantly associated with higher adjusted mortality even beyond 3 years (1.25; 95 CI 1.01-1.54). ConclusionIn-hospital major bleeding is associated with short-, intermediate-, and long-term mortality among older patients hospitalized for NSTEMIthis association is strongest within the first 30 days, but remains significant long term, particularly among PCI-treated patients. Despite a probable early hazard related to bleeding, the longer duration of risk in patients who bleed casts doubt on its causal relationship with long-term mortality. Rather, major bleeding likely identifies patients with an underlying risk for mortality.

Original languageEnglish (US)
Pages (from-to)2044-2053
Number of pages10
JournalEuropean heart journal
Volume33
Issue number16
DOIs
StatePublished - Aug 2012
Externally publishedYes

Keywords

  • Acute myocardial infarction
  • Bleeding
  • Elderly patients
  • Outcomes
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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