Major In-Hospital Bleeding Increases Mortality Risk in AMI Complicated by Cardiogenic Shock

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.

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