TY - JOUR
T1 - The association of in-hospital major bleeding with short-, intermediate-, and long-term mortality among older patients with non-ST-segment elevation myocardial infarction
AU - Lopes, Renato D.
AU - Subherwal, Sumeet
AU - Holmes, Dajuanicia N.
AU - Thomas, Laine
AU - Wang, Tracy Y.
AU - Rao, Sunil V.
AU - Magnus Ohman, Erik
AU - Roe, Matthew T.
AU - Peterson, Eric D.
AU - Alexander, Karen P.
N1 - Funding Information:
CRUSADE is funded by the Schering-Plough Corporation. Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership provides additional funding support. Millennium Pharmaceuticals, Inc., also funded this work. This work was also supported in part by a grant from the National Institute on Aging (R01 AG025312-01A1, E.D.P.).
PY - 2012/8
Y1 - 2012/8
N2 - 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.
AB - 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.
KW - Acute myocardial infarction
KW - Bleeding
KW - Elderly patients
KW - Outcomes
KW - Percutaneous coronary intervention
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U2 - 10.1093/eurheartj/ehs012
DO - 10.1093/eurheartj/ehs012
M3 - Article
C2 - 22396323
AN - SCOPUS:84865206211
SN - 0195-668X
VL - 33
SP - 2044
EP - 2053
JO - European heart journal
JF - European heart journal
IS - 16
ER -