PMID- 23953696
OWN - NLM
STAT- MEDLINE
DCOM- 20140107
LR  - 20131104
IS  - 1879-1913 (Electronic)
IS  - 0002-9149 (Linking)
VI  - 112
IP  - 10
DP  - 2013 Nov 15
TI  - In-hospital major bleeding and its clinical relevance in patients with ST 
      elevation myocardial infarction treated with primary percutaneous coronary 
      intervention.
PG  - 1533-9
LID - S0002-9149(13)01505-1 [pii]
LID - 10.1016/j.amjcard.2013.06.025 [doi]
AB  - Advances in antithrombotic therapy for ST elevation myocardial infarction (STEMI) 
      enhance the risk of bleeding. Therefore, the incidence, determinants, and 
      prognostic implications of in-hospital major bleeding after primary percutaneous 
      coronary intervention for STEMI were investigated. In 963 consecutive patients, 
      the incidence of bleeding was evaluated according to commonly used 
      classifications including Can Rapid risk stratification of Unstable angina 
      patients Suppress Adverse outcomes with Early implementation of the ACC/AHA 
      guidelines, Thrombolysis In Myocardial Infarction, Global Use of Strategies To 
      Open coronary arteries, and Bleeding Academic Research Consortium. Multivariate 
      regression analyses investigated determinants of bleeding and the relation 
      between bleeding and 1-year all-cause mortality. Large variability in incidence 
      existed depending on classification (1.3% to 21%). Female gender, heart rate, 
      creatinine, multivessel disease, cardiogenic shock, and procedural failure were 
      independently associated with bleeding. One-year mortality reached 10.2% in 
      bleeders versus 2.0% in nonbleeders (p <0.001). Bleeding was independently 
      associated with an increased risk of 1-year mortality (hazard ratio [HR] 2.41, p 
      <0.017). Assessment of individual classifications confirmed the increased risk of 
      mortality for Bleeding Academic Research Consortium (HR 2.27, p = 0.048), but not 
      for Can Rapid risk stratification of Unstable angina patients Suppress Adverse 
      outcomes with Early implementation of the ACC/AHA guidelines, Thrombolysis In 
      Myocardial Infarction, and Global Use of Strategies To Open coronary arteries 
      bleeding. Thrombotic events occurred more frequently in bleeders (5.8% vs 1.5%, p 
      <0.001); however, bleeding remained independently related to mortality with a 
      negligible reduction in HR (2.25, p = 0.028) after adjustment. In conclusion, 
      in-hospital major bleeding was frequently observed after STEMI, but a widespread 
      variation in incidence existed depending on the applied definition. Patient and 
      procedural characteristics were related to bleeding, allowing identification of 
      high-risk patients. In-hospital major bleeding was independently associated with 
      1-year all-cause mortality; however, not all bleeding classifications proved 
      equally relevant to prognosis. The relation between bleeding and mortality was 
      shown not to be driven by the higher rate of thrombotic events among bleeders.
CI  - Copyright (c) 2013 Elsevier Inc. All rights reserved.
FAU - Boden, Helen
AU  - Boden H
AD  - Department of Cardiology, Leiden University Medical Center, Leiden, The 
      Netherlands.
FAU - Velders, Matthijs A
AU  - Velders MA
FAU - van der Hoeven, Bas L
AU  - van der Hoeven BL
FAU - Cannegieter, Suzanne C
AU  - Cannegieter SC
FAU - Schalij, Martin J
AU  - Schalij MJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20130814
PL  - United States
TA  - Am J Cardiol
JT  - The American journal of cardiology
JID - 0207277
SB  - IM
MH  - *Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hemorrhage/epidemiology/*etiology
MH  - Humans
MH  - Incidence
MH  - *Inpatients
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/mortality/physiopathology/*therapy
MH  - Netherlands/epidemiology
MH  - Percutaneous Coronary Intervention/*methods
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Rate/trends
MH  - Thrombolytic Therapy/*adverse effects
EDAT- 2013/08/21 06:00
MHDA- 2014/01/08 06:00
CRDT- 2013/08/20 06:00
PHST- 2013/04/22 00:00 [received]
PHST- 2013/06/24 00:00 [revised]
PHST- 2013/06/24 00:00 [accepted]
PHST- 2013/08/20 06:00 [entrez]
PHST- 2013/08/21 06:00 [pubmed]
PHST- 2014/01/08 06:00 [medline]
AID - S0002-9149(13)01505-1 [pii]
AID - 10.1016/j.amjcard.2013.06.025 [doi]
PST - ppublish
SO  - Am J Cardiol. 2013 Nov 15;112(10):1533-9. doi: 10.1016/j.amjcard.2013.06.025. 
      Epub 2013 Aug 14.