In-hospital outcomes associated with fibrinolytic and thienopyridine use in patients with ST-segment elevation acute myocardial infarction. The global registry of acute coronary events.
OBJECTIVE
To investigate how thienopyridine treatment, with or without associated fibrinolysis, affects the rates of major bleeding and inhospital death in patients with ST-elevation myocardial infarction (STEMI).


METHODS
The rates of major bleeding and in-hospital death were studied in 14,259 consecutive patients with STEMI. During hospitalization, 5340 (38%) received thienopyridines, 3007 (21%) received fibrinolytic drugs, and 2044 (14%) received both.


RESULTS
Major bleeding occurred more frequently in patients who received thienopyridines with or without fibrinolytics, in 4.6% and 4.1%, respectively, compared with 2.3% in those who received fibrinolytics alone and 2.8% in those who received neither (P< .001). Multivariate analysis, which included adjustments for risk factors for bleeding, percutaneous coronary intervention and cardiac catheterization, showed that thienopyridine treatment was an independent risk factor for bleeding (odds ratio=1.68; 95% confidence interval, 1.23-2.31). In-hospital mortality was lower in patients who received a thienopyridine, and such treatment was an independent predictor of lower mortality (odds ratio=0.50; 95% confidence interval, 0.39-0.60).


CONCLUSIONS
Thienopyridine treatment was associated with an increased risk of major bleeding but also with a better in-hospital prognosis. These findings in unselected patients with STEMI, who are representative of those seen in daily clinical practice, complement, but do not replace, the data obtained in randomized clinical trails of selected patients.
López-Sendón
José
J
Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain. jlsendon@terra.es
Dabbous
Omar H
OH
López de Sá
Esteban
E
Stiles
Martin
M
Gore
Joel M
JM
Brieger
David
D
van de Werf
Frans
F
Budaj
Andrzej
A
Gurfinkel
Enrique P
EP
Fox
Keith Aa
KA
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000453:epidemiology*; D004562:Electrocardiography; D023381:Endpoint Determination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D012042:Registries
D005343:Fibrinolytic Agents; D011725:Pyridines; C446540:thienopyridine