Adverse Impact of Bleeding on Prognosis in Patients With Acute Coronary Syndromes

• DOI: 10.1161/circulationaha.106.612812
• Publication Date: 2006-08-15T00:33:44Z
• Authors: John W. Eikelboom; Shamir R. Mehta; Sonia S. Anand; Changchun Xie; Keith A.A. Fox; Salim Yusuf
• Keywords: Unstable angina; Stroke

The use of multiple antithrombotic drugs and aggressive invasive strategies has increased the risk major bleeding in acute coronary syndrome (ACS) patients. It is not known to what extent determines clinical outcome.Using Cox proportional-hazards modeling, we examined association between death or ischemic events 34,146 patients with ACS enrolled Organization Assess Ischemic Syndromes Clopidogrel Unstable Angina Prevent Recurrent Events studies. Patients were older, more often had diabetes a history stroke, lower blood pressure higher serum creatinine, ST-segment changes on presenting ECG, 5-fold-higher incidence during first 30 days (12.8% versus 2.5%; P < 0.0001) 1.5-fold-higher 6 months (4.6% 2.9%; = 0.002). Major was independently associated an hazard (hazard ratio, 5.37; 95% CI, 3.97 7.26; 0.0001), but much weaker after 1.54; 1.01 2.36; 0.047). consistent across subgroups according cointerventions hospitalization, there increasing severity (minor less than life-threatening; for trend 0.0009). A similar evident events, including myocardial infarction stroke.In without persistent elevation, strong, consistent, temporal, dose-related death. These data should lead greater awareness prognostic importance prompt evaluation reduce thereby improve outcomes.