Patients with acute myocardial infarction (MI) complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI) were at increased risk for all-cause mortality following an in-hospital bleeding event. These findings from a prospective observational study were published in the European Heart Journal: Acute Cardiovascular Care.

Data from JAMIR, the Japan Acute Myocardial Infarction Registry, were analyzed for this study. Patients (N=335) with acute MI complicated by cardiogenic shock undergoing PCI at 50 centers in Japan between 2015 and 2017 were assessed for bleeding and mortality risk.

Patients had a mean age of 71.3±13.6 years, and 28.4% were women. Of these patients, 68.4% had dyslipidemia, 62.4% had hypertension, 38.8% had diabetes mellitus, 15.8% had a previous MI, and 14.3% had a previous stroke.


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A total of 14.6% had an in-hospital major bleeding event.

Predictors of a bleeding event were switching between prasugrel and clopidogrel (odds ratio [OR], 4.89; 95% CI, 1.41-16.98; P =.013), left main coronary artery culprit lesion (OR, 3.06; 95% CI, 1.10-8.52; P =.032), intra-aortic balloon pump (IABP) or extracorporeal membrane oxygenation (ECMO; OR, 2.63; 95% CI, 1.07-6.47; P =.035), estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (OR, 2.59; 95% CI, 1.11-6.04; P =.027), and longer door-to-device time (OR, 2.41; 95% CI, 1.09-5.35; P =.030).

All-cause mortality at 1-year was increased among patients who experienced an in-hospital major bleeding event (63.8% vs 25.5%; P <.001).

Increased risk for all-cause mortality was associated with left main coronary artery culprit lesion (adjusted hazard ratio [aHR], 3.10; 95% CI, 1.75-5.46; P <.001), final thrombolysis in MI flow grade <3 (aHR, 1.90; 95% CI, 1.14-3.19; P =.014), eGFR <30 mL/min/1.73 m2 (aHR, 1.89; 95% CI, 1.21-2.96; P =.005), age of 75 years or older (aHR, 1.81; 95% CI, 1.19-2.74; P =.005), IABP or ECMO (aHR, 1.75; 95% CI, 1.08-2.83; P =.0023), longer door-to-device time (aHR, 1.73; 95% CI, 1.14-2.64; P =.010), multivessel disease (aHR, 1.73; 95% CI, 1.09-2.75; P =.020), and major in-hospital bleeding (aHR, 1.70; 95% CI, 1.08-2.69; P =.023).

All-cause mortality was decreased among patients using dual antiplatelet therapy (aHR, 0.27; 95% CI, 0.15-0.51; P <.001).

This study may have been underpowered and included some selection bias.

These results suggested that patients who experienced in-hospital bleeding associated with a PCI for acute MI complicated by cardiogenic shock were at increased risk for all-cause mortality for up to 1 year.

Disclosure: This research was supported by Daiichi Sankyo. Please refer to the original article for a full list of disclosures.

Reference

Nishihira K, Honda S, Takegami M, et al. Impact of bleeding on mortality in patients with acute myocardial infarction complicated by cardiogenic shock. Eur Heart J Acute Cardiovasc Care. Published online May 3, 2021. doi:10.1093/ehjacc/zuab014