Document Detail


Associations of major bleeding and myocardial infarction with the incidence and timing of mortality in patients presenting with non-ST-elevation acute coronary syndromes: a risk model from the ACUITY trial.
MedLine Citation:
PMID:  19351691     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: To evaluate the associations of myocardial infarction (MI) and major bleeding with 1-year mortality. Both MI and major bleeding predict 1-year mortality in patients presenting with acute coronary syndrome (ACS). However, the risk of each of these events on the magnitude and timing of mortality has not been well studied.
METHODS AND RESULTS: A multivariable Cox regression model was developed relating 13 independent baseline predictors to 1-year mortality for 13 819 patients with moderate and high-risk ACS enrolled in the Acute Catheterization and Urgent Intervention Triage strategy trial. After adjustment for baseline predictors, Cox models with major bleeding and recurrent MI as time-updated covariates estimated the effect of these events on mortality hazard over time. Within 30 days of randomization, 705 patients (5.1%) had an MI, 645 (4.7%) had a major bleed; 524 (3.8%) died within a year. The occurrence of an MI was associated with a hazard ratio of 3.1 compared with patients not yet having an MI, after adjustment for baseline predictors. However, MI within 30 days markedly increased the mortality risk for the first 2 days after the event (adjusted hazard ratio of 17.6), but this risk declined rapidly post-infarct (hazard ratio of 1.4 beyond 1 month after the MI event). In contrast, major bleeding had a prolonged association with mortality risk (hazard ratio of 3.5) which remained fairly steady over time throughout 1 year.
CONCLUSION: After accounting for baseline predictors of mortality, major bleeds and MI have similar overall strength of association with mortality in the first year after ACS. MI is correlated with a dramatic increase in short-term risk, whereas major bleeding correlates with a more prolonged mortality risk.
Authors:
Roxana Mehran; Stuart J Pocock; Gregg W Stone; Tim C Clayton; George D Dangas; Frederick Feit; Steven V Manoukian; Eugenia Nikolsky; Alexandra J Lansky; Ajay Kirtane; Harvey D White; Antonio Colombo; James H Ware; Jeffrey W Moses; E Magnus Ohman
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2009-04-07
Journal Detail:
Title:  European heart journal     Volume:  30     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-15     Completed Date:  2009-07-28     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1457-66     Citation Subset:  IM    
Affiliation:
Columbia University Medical Center and Cardiovascular Research Foundation, 161 Fort Washington Avenue, New York, NY 10032, USA. rmehran@crf.org
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy,  mortality*
Aged
Coronary Angiography
Creatine Kinase, MB Form / blood
Epidemiologic Methods
Female
Hemorrhage / complications,  mortality*,  therapy
Humans
Male
Middle Aged
Myocardial Infarction / complications,  mortality*,  therapy
Thrombolytic Therapy / methods
Time Factors
Troponin / blood
Chemical
Reg. No./Substance:
0/Troponin; EC 2.7.3.2/Creatine Kinase, MB Form
Comments/Corrections

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