Relations between bleeding and outcomes in patients with ST-elevation myocardial infarction in the ExTRACT-TIMI 25 trial

Giugliano, Robert P.; Giraldez, Roberto R.; Morrow, David A.; Antman, Elliott M.; Gibson, C. Michael; Mohanavelu, Satishkumar; Murphy, Sabina A.; McCabe, Carolyn H.; Braunwald, Eugene

doi:10.1093/eurheartj/ehq100

Cited by 37 publications

(35 citation statements)

References 23 publications

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“…9 Despite these studies, which mixed ST-elevation and non-ST-elevation MI, one can expect that the falling prevalence of HS is partly explained by the shift in reperfusion strategies from thrombolysis to percutaneous coronary intervention. 9 Giugliano et al 10 reported 30-day mortality of 65.4% after intracranial hemorrhage, rising to 71.8% at 1 year. Independent predictors of HS have already been described.…”

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confidence: 99%

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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Background and Purpose-Stroke is a serious complication after acute myocardial infarction (AMI) and is closely associated with decreased survival. This study aimed to investigate the frequency, characteristics, and factors associated with in-hospital and postdischarge stroke in patients with AMI. Methods-Eight thousand four hundred eighty-five consecutive patients admitted to a cardiology intensive care unit for AMI, between January 2001 and July 2010. Stroke/transient ischemic attack were collected during 1-year follow-up. Results-One hundred twenty-three in-hospital strokes were recorded: 65 (52.8%) occurred on the first day after admission for AMI, and 108 (87%) within the first 5 days. One hundred six patients (86.2%-incidence rate 1.25%) experienced inhospital ischemic stroke, and 14 patients (11.4%-incidence rate 0.16%) were diagnosed with an in-hospital hemorrhagic stroke. In-hospital ischemic stroke subtypes according to the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) classification showed that only 2 types of stroke were identified more frequently. As expected, the leading subtype of in-hospital ischemic stroke was cardioembolic stroke (n=64, 60%), the second was stroke of undetermined pathogenesis (n=38, 36%). After multivariable backward regression analysis, female sex, previous transient ischemic attack (TIA)/ stroke, new-onset atrial fibrillation, left ventricular ejection fraction (odds ratio per point of left ventricular ejection fraction), and C-reactive protein were independently associated with in-hospital ischemic stroke. When antiplatelet and anticoagulation therapy within the first 48 hours was introduced into the multivariable model, we found that implementing these treatments (≥1) was an independent protective factor of in-hospital stroke. In-hospital hemorrhagic stroke was dramatically increased (5-fold) when thrombolysis was prescribed as the reperfusion treatment. However, the different parenteral anticoagulants were not predictors of risk in univariable analysis. Finally, only 45 postdischarge strokes were recorded. Postdischarge stroke subtypes showed a more heterogeneous distribution of mechanisms. The annual rate of stroke post-AMI remained stable throughout the 10-year study period. Conclusions-The present study describes specific predictors of in-hospital and postdischarge stroke in patients with AMI. It showed a marked increase in the risk of death, both during hospitalization and in the year after AMI. After hospital discharge, stroke remains a rare event and is mostly associated with high cardiovascular risk. (Stroke. 2014;45:3514-3520.)

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confidence: 99%

Frequency and Predictors of Stroke After Acute Myocardial Infarction

Hachet

Guenancia

Stamboul

et al. 2014

Stroke

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“…11 One study found a 1-year mortality rate after hemorrhagic stroke of 71.8% in a selected population of patients with AMI treated with thrombolysis. 12 The risk of hemorrhagic stroke after AMI is closely related to the use of thrombolytic therapy, whereas ischemic stroke has other, partly unknown, mechanisms. It is, therefore, of interest to analyze ischemic stroke separately.…”

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confidence: 99%

Mortality After Ischemic Stroke in Patients With Acute Myocardial Infarction

Brammås

Jakobsson

Ulvenstam

et al. 2013

Stroke

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Background and Purpose-Acute myocardial infarction (AMI) increases the risk of ischemic stroke, and mortality among these patients is high. Here, we aimed to estimate the 1-year mortality reliably after AMI complicated by ischemic stroke. We also aimed to identify trends over time for mortality during 1998-2008, as well as factors that predicted increased or decreased mortality. Methods-Data for 173 233 unselected patients with AMI were collected from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions registry for 1998-2008. Specifically, we analyzed 1-year follow-up and mortality data for patients with AMI with and without ischemic stroke. Kaplan-Meyer analysis was used to analyze mortality trends over time, and Cox regression analysis was used to identify uni-and multivariate predictors of mortality. Results-The 1-year mortality was 36.5% for AMI complicated by ischemic stroke and 18.3% for AMI without stroke.Mortality decreased over time in patients with and without ischemic stroke. The absolute decreases in mortality were 9.4% and 7.5%, respectively. Reperfusion and secondary preventive therapies were associated with a decreased mortality rate. Conclusions-Mortality

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“…18 The role played by transfusion is particularly relevant in the work by Mehta et al, 2 because the majority of bleeding events were managed with transfusion. The relationship between bleeding and mortality is also complicated by the marked differences in fatality rates dependent on the location of the bleed (intracranial versus nonintracranial), 19 which varied 10-fold between patients receiving fibrinolysis and those undergoing PPCI in National Registry of Myocardial Infarction-4 and -5. Additional considerations include the occurrence of other intervening medical events that themselves may lead to bleeding and death (eg, cardiogenic shock) and the biological plausibility of the relationship given the reported cause(s) of death.…”

Section: Article See P 1727mentioning

confidence: 99%

“…Additional considerations include the occurrence of other intervening medical events that themselves may lead to bleeding and death (eg, cardiogenic shock) and the biological plausibility of the relationship given the reported cause(s) of death. 19 Unfortunately, similar to Operation Market Garden, 20 in which overstretched Allied forces failed to hold positions crossing over the River Rhine, thereby coining the infamous phrase "a bridge too far," the authors have overextended their data, speculating that higher rates of bleeding in African Americans may explain higher long-term mortality observed in other data sets. In fact, temporal analyses of bleeding and mortality demonstrate a waning of the strength of the association as the time interval increases, 21 with no significant effect after 40 days.…”

Section: Article See P 1727mentioning

confidence: 99%

“…21 In addition, a landmark analysis from the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment, Thrombolysis in Myocardial Infarction-Study 25 (ExTRACT-TIMI 25) trial showed no independent relationship between either nonintracranial TIMI major bleeding in hospital and death at 31 to 365 days, or TIMI minor bleeding in hospital and death at 31 to 365 days, once baseline characteristics were included in multivariate models. 19 Nevertheless, reducing bleeding is ipso facto desirable, and position statements 22 have endorsed attempts to reduce bleeding in patients with acute coronary syndromes. Several promising strategies, such as use of radial arterial access 23 and safer anticoagulants 24 are rapidly being implemented, contributing to a recent decline in bleeding rates.…”

Section: Article See P 1727mentioning

confidence: 99%

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