Research
Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital
Published

Bleeding Events After ST-segment Elevation Myocardial Infarction in Patients Randomized to an All-comer Clinical Trial Compared With Unselected Patients

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Assessment of Predictors of Left Atrial Volume Response to a Transcatheter InterAtrial Shunt Device (from the REDUCE LAP-HF Trial)

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Causes of Mortality in the Marfan Syndrome(from a Nationwide Register Study)

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Prevalence and incidence of various Cancer subtypes in patients with heart failure vs matched controls

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Self-reported health status and the associated risk of mortality in heart failure: The DANISH trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Vascular function in adults with cyanotic congenital heart disease

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery

    Research output: Contribution to journalJournal articleResearchpeer-review

View graph of relations

Most studies reporting bleedings in patients with ST-segment elevation myocardial infarction (STEMI) are reports from clinical trials, which may be unrepresentative of incidences in real-life. In this study, we investigated 1-year bleeding and mortality incidences in an unselected STEMI population, and compared participants with nonparticipants of a randomized all-comer clinical trial (The Third DANish Study of Optimal Acute Treatment of Patients with STEMI (DANAMI-3)). Hospital charts were read and bleedings classified according to thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium (BARC) criteria in 2,490 consecutive STEMI patients who underwent primary percutaneous coronary intervention in a single, large, and tertiary heart center. Thrombolysis in myocardial infarction minor and/or major bleeding (TMMB) occurred in 4.4% day 0 to 30 and 2.1% day 31 to 365. DANAMI-3 nonparticipants (n = 887) had significantly higher 30-day bleeding rates than DANAMI-3-participants (n = 1,603) (7.2% vs 2.9%, p <0.0001), but not thereafter (p = 0.8). DANAMI-3 nonparticipation was significantly associated with 30-day TMMB (hazard ratio, 1.8, 95% confidence interval, 1.2 to 2.8, p = 0.007), but this did not persist after adjusting for resuscitated cardiac arrest, Killip-class>2 and anemia. Patients with cardiac arrest, Killip-class>2, and anemia accounted for 70.0% of 30-day TMMBs, and the majority of these patients were DANAMI-3 nonparticipants. TMMB day 0 to 30 was associated with increased 30-day mortality (hazard ratio 3.1, 95% confidence interval 1.9 to 5.2, p <0.0001) but not thereafter (p = 0.9). In conclusion, we found that clinical trial (DANAMI-3) nonparticipants had significantly more TMMBs within 30 days than participants. Patients with resuscitated cardiac arrest, anemia, and Killip-class>2 were accountable for a high rate of TMMBs. Bleeding incidences from clinical trials cannot be translated to an unselected STEMI population.

Original languageEnglish
JournalThe American journal of cardiology
Volume122
Issue number8
Pages (from-to)1287-1296
Number of pages10
ISSN0002-9149
DOIs
Publication statusPublished - 15 Oct 2018

ID: 56240709