Document Detail

Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events.
MedLine Citation:
PMID:  20007159     Owner:  NLM     Status:  MEDLINE    
AIMS: To determine whether changes in practice, over time, are associated with altered rates of major bleeding in acute coronary syndromes (ACS).
METHODS AND RESULTS: Patients from the Global Registry of Acute Coronary Events were enrolled between 2000 and 2007. The main outcome measures were frequency of major bleeding, including haemorrhagic stroke, over time, after adjustment for patient characteristics, and impact of major bleeding on death and myocardial infarction. Of the 50 947 patients, 2.3% sustained a major bleed; almost half of these presented with ST-elevation ACS (44%, 513). Despite changes in antithrombotic therapy (increasing use of low molecular weight heparin, P < 0.0001), thienopyridines (P < 0.0001), and percutaneous coronary interventions (P < 0.0001), frequency of major bleeding for all ACS patients decreased (2.6 to 1.8%; P < 0.0001). Most decline was seen in ST-elevation ACS (2.9 to 2.1%, P = 0.02). The overall decline remained after adjustment for patient characteristics and treatments (P = 0.002, hazard ratio 0.94 per year, 95% confidence interval 0.91-0.98). Hospital characteristics were an independent predictor of bleeding (P < 0.0001). Patients who experienced major bleeding were at increased risk of death within 30 days from admission, even after adjustment for baseline variables.
CONCLUSION: Despite increasing use of more intensive therapies, there was a decline in the rate of major bleeding associated with changes in clinical practice. However, individual hospital characteristics remain an important determinant of the frequency of major bleeding.
Keith A A Fox; Kathryn Carruthers; Ph Gabriel Steg; Alvaro Avezum; Christopher B Granger; Gilles Montalescot; Shaun G Goodman; Joel M Gore; Ann L Quill; Kim A Eagle;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-12-08
Journal Detail:
Title:  European heart journal     Volume:  31     ISSN:  1522-9645     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-16     Completed Date:  2011-04-28     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  667-75     Citation Subset:  IM    
Cardiovascular Research, Division of Medical and Radiological Sciences, The University of Edinburgh, Edinburgh, UK.
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MeSH Terms
Acute Coronary Syndrome / mortality,  therapy*
Aged, 80 and over
Angioplasty, Balloon, Coronary / adverse effects*,  trends
Coronary Artery Bypass / adverse effects*,  mortality
Hematoma, Subdural / etiology
Hemorrhage / etiology*,  mortality,  prevention & control
Kaplan-Meier Estimate
Professional Practice / standards*,  trends
Prospective Studies
Stroke / etiology
Thrombolytic Therapy / adverse effects*,  mortality,  trends
Grant Support
//British Heart Foundation
Comment In:
Eur Heart J. 2010 Mar;31(6):640-1   [PMID:  20038514 ]

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