Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

Golnaz Sadjadieh; Thomas Engstrøm; Steffen Helqvist; Dan Eik Høfsten; Lars Køber; Frants Pedersen; Peter Nørkjær Laursen; Lars Nepper-Christensen; Peter Clemmensen; Ole Kristian Møller-Helgestad; Rikke Sørensen; Jan Ravkilde; Christian Juhl Terkelsen; Erik Jørgensen; Kari Saunamäki; Hans-Henrik Tilsted; Henning Kelbæk; Lene Holmvang

doi:10.1016/j.amjcard.2017.12.019

Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

Golnaz Sadjadieh, Thomas Engstrøm, Steffen Helqvist, Dan Eik Høfsten, Lars Køber, Frants Pedersen, Peter Nørkjær Laursen, Lars Nepper-Christensen, Peter Clemmensen, Ole Kristian Møller-Helgestad, Rikke Sørensen, Jan Ravkilde, Christian Juhl Terkelsen, Erik Jørgensen, Kari Saunamäki, Hans-Henrik Tilsted, Henning Kelbæk, Lene Holmvang

Department of Clinical Medicine

2 Citations (Scopus)

Abstract

Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

Original language	English
Journal	The American Journal of Cardiology
Volume	121
Issue number	7
Pages (from-to)	781-788
ISSN	0002-9149
DOIs	https://doi.org/10.1016/j.amjcard.2017.12.019
Publication status	Published - 1 Apr 2018

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10.1016/j.amjcard.2017.12.019

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Sadjadieh, G., Engstrøm, T., Helqvist, S., Høfsten, D. E., Køber, L., Pedersen, F., Laursen, P. N., Nepper-Christensen, L., Clemmensen, P., Møller-Helgestad, O. K., Sørensen, R., Ravkilde, J., Terkelsen, C. J., Jørgensen, E., Saunamäki, K., Tilsted, H.-H., Kelbæk, H., & Holmvang, L. (2018). Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy). The American Journal of Cardiology, 121(7), 781-788. https://doi.org/10.1016/j.amjcard.2017.12.019

Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy). / Sadjadieh, Golnaz; Engstrøm, Thomas; Helqvist, Steffen et al.
In: The American Journal of Cardiology, Vol. 121, No. 7, 01.04.2018, p. 781-788.

Research output: Contribution to journal › Journal article › Research › peer-review

Sadjadieh, G, Engstrøm, T, Helqvist, S, Høfsten, DE, Køber, L, Pedersen, F, Laursen, PN, Nepper-Christensen, L, Clemmensen, P, Møller-Helgestad, OK, Sørensen, R, Ravkilde, J, Terkelsen, CJ, Jørgensen, E, Saunamäki, K, Tilsted, H-H, Kelbæk, H & Holmvang, L 2018, 'Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)', The American Journal of Cardiology, vol. 121, no. 7, pp. 781-788. https://doi.org/10.1016/j.amjcard.2017.12.019

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title = "Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)",

abstract = "Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.",

author = "Golnaz Sadjadieh and Thomas Engstr{\o}m and Steffen Helqvist and H{\o}fsten, {Dan Eik} and Lars K{\o}ber and Frants Pedersen and Laursen, {Peter N{\o}rkj{\ae}r} and Lars Nepper-Christensen and Peter Clemmensen and M{\o}ller-Helgestad, {Ole Kristian} and Rikke S{\o}rensen and Jan Ravkilde and Terkelsen, {Christian Juhl} and Erik J{\o}rgensen and Kari Saunam{\"a}ki and Hans-Henrik Tilsted and Henning Kelb{\ae}k and Lene Holmvang",

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doi = "10.1016/j.amjcard.2017.12.019",

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T1 - Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

AU - Sadjadieh, Golnaz

AU - Engstrøm, Thomas

AU - Helqvist, Steffen

AU - Høfsten, Dan Eik

AU - Køber, Lars

AU - Pedersen, Frants

AU - Laursen, Peter Nørkjær

AU - Nepper-Christensen, Lars

AU - Clemmensen, Peter

AU - Møller-Helgestad, Ole Kristian

AU - Sørensen, Rikke

AU - Ravkilde, Jan

AU - Terkelsen, Christian Juhl

AU - Jørgensen, Erik

AU - Saunamäki, Kari

AU - Tilsted, Hans-Henrik

AU - Kelbæk, Henning

AU - Holmvang, Lene

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

AB - Bleeding events in relation to treatment of ST-segment elevation myocardial infarction (STEMI) have previously been associated with mortality. In this study, we investigated the incidence and prognosis of, and variables associated with serious bleedings within 30 days after primary percutaneous coronary intervention in patients from The Third Danish Study of Optimal Acute Treatment of Patients with ST-Segment Elevation Myocardial Infarction (DANAMI-3) (n = 2,217). Hospital charts were read within 30 days postadmission to assess bleeding events using thrombolysis in myocardial infarction (TIMI) and Bleeding Academic Research Consortium criteria. TIMI minor/major bleeding (TMMB) occurred in 59 patients (2.7%). Variables associated with TMMB were female gender (hazard ratio [HR] 3.9, 95% confidence interval [CI] 2.2 to 6.7, p <0.0001), symptom-to-catheterization time >3 hours (HR 1.9, 95% CI 1.1 to 3.3, p = 0.02), use of glycoprotein IIb/IIIa inhibitor (HR 2.1, 95% CI 1.2 to 3.7, p = 0.01), and increasing S-creatinine (HR 1.1, 95% CI 1.0 to 1.2, p = 0.001). Undergoing 2 in-hospital procedures were not associated with increased risk of TMMB. TMMB was strongly associated with 30-day mortality in multivariable analysis (HR 4.8, 95% CI 2.2 to 10.4, p <0.0001) but not with mortality days 31 to 365. When excluding fatal bleedings from the analysis, a TMMB was no longer associated with 30-day mortality. In conclusion, we found that in a contemporary STEMI-population, the incidence of 30-day TMMB was low. A TMMB was strongly associated with 30-day mortality but not with mortality days 31 to 365. If patients survived a serious bleeding, their short- and long-term prognoses were not affected.

U2 - 10.1016/j.amjcard.2017.12.019

DO - 10.1016/j.amjcard.2017.12.019

M3 - Journal article

C2 - 29402421

SN - 0002-9149

VL - 121

SP - 781

EP - 788

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

IS - 7

ER -

Relation of Bleeding Events to Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated by Percutaneous Coronary Intervention (a DANAMI-3 Substudy)

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