TY - JOUR
T1 - Incidence and outcomes of high bleeding risk patients with type 1 and type 2 myocardial infarction in a community-based cohort
T2 - Application of the Academic Research Consortium High Bleeding Risk Criteria
AU - Breen, Thomas J.
AU - Raphael, Claire E.
AU - Ingraham, Brenden
AU - Lane, Conor
AU - Huxley, Sam
AU - Roger, Veronique L.
AU - Jaffe, Allan
AU - Lewis, Bradley
AU - Sandoval, Yader B.
AU - Prasad, Abhiram
AU - Rihal, Charanjit S.
AU - Gulati, Rajiv
AU - Singh, Mandeep
N1 - Publisher Copyright:
© 2023
PY - 2024/2/1
Y1 - 2024/2/1
N2 - Background and aims: The incidence and outcomes of high bleeding risk (HBR) patients in a community cohort according to the Academic Research Consortium (ARC) criteria is not known. We hypothesized that HBR is common and associated with worse outcomes for all-comers with myocardial infarction. Methods: We prospectively collected all patients with cardiac troponin T > 99th percentile upper limit of normal (≥0.01 ng/mL) in Olmsted County between 2003 and 2012. Events were retrospectively classified as type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), or myocardial injury. Patients were further classified as HBR based on the “ARC-HBR definition.” Outcomes included all-cause mortality, cardiovascular mortality, recurrent MI, stroke, and major bleeding. Results: 2419 patients were included in the final study; 1365 were classified as T1MI and 1054 as T2MI. Patients were followed for a median of 5.5 years. ARC-HBR was more common in T2MI than T1MI (73% vs 46%, p < 0.001). Among patients with T1MI, HBR was associated with higher all-cause mortality (HR 3.7, 95% CI 3.2–4.5, p < 0.001), cardiovascular mortality (4.7, 3.6–6.3, p < 0.001), recurrent MI (2.1, 1.6–2.7, p < 0.001), stroke (4.9, 2.9–8.4, p < 0.001), and major bleeding (6.5, 3.7–11.4, p < 0.001). For T2MI, HBR was similarly associated with higher all-cause mortality (HR 2.1, 95% CI 1.8–2.5, p < 0.001), cardiovascular mortality (2.7, 1.8–4.0, p < 0.001), recurrent MI (1.7, 1.1–2.6, p = 0.02) and major bleeding (HR 15.6, 3.8–63.8, p < 0.001). Conclusion: HBR is common among unselected patients with T1MI and T2MI and is associated with increased overall and cardiovascular mortality, recurrent cardiovascular events, and major bleeding on long-term follow up.
AB - Background and aims: The incidence and outcomes of high bleeding risk (HBR) patients in a community cohort according to the Academic Research Consortium (ARC) criteria is not known. We hypothesized that HBR is common and associated with worse outcomes for all-comers with myocardial infarction. Methods: We prospectively collected all patients with cardiac troponin T > 99th percentile upper limit of normal (≥0.01 ng/mL) in Olmsted County between 2003 and 2012. Events were retrospectively classified as type 1 myocardial infarction (T1MI), type 2 myocardial infarction (T2MI), or myocardial injury. Patients were further classified as HBR based on the “ARC-HBR definition.” Outcomes included all-cause mortality, cardiovascular mortality, recurrent MI, stroke, and major bleeding. Results: 2419 patients were included in the final study; 1365 were classified as T1MI and 1054 as T2MI. Patients were followed for a median of 5.5 years. ARC-HBR was more common in T2MI than T1MI (73% vs 46%, p < 0.001). Among patients with T1MI, HBR was associated with higher all-cause mortality (HR 3.7, 95% CI 3.2–4.5, p < 0.001), cardiovascular mortality (4.7, 3.6–6.3, p < 0.001), recurrent MI (2.1, 1.6–2.7, p < 0.001), stroke (4.9, 2.9–8.4, p < 0.001), and major bleeding (6.5, 3.7–11.4, p < 0.001). For T2MI, HBR was similarly associated with higher all-cause mortality (HR 2.1, 95% CI 1.8–2.5, p < 0.001), cardiovascular mortality (2.7, 1.8–4.0, p < 0.001), recurrent MI (1.7, 1.1–2.6, p = 0.02) and major bleeding (HR 15.6, 3.8–63.8, p < 0.001). Conclusion: HBR is common among unselected patients with T1MI and T2MI and is associated with increased overall and cardiovascular mortality, recurrent cardiovascular events, and major bleeding on long-term follow up.
KW - Coronary artery disease
KW - Epidemiology
KW - High bleeding risk
KW - Ischemic heart disease
KW - Myocardial infarction
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U2 - 10.1016/j.ijcard.2023.131565
DO - 10.1016/j.ijcard.2023.131565
M3 - Article
C2 - 37913957
AN - SCOPUS:85176283143
SN - 0167-5273
VL - 396
JO - International Journal of Cardiology
JF - International Journal of Cardiology
M1 - 131565
ER -