Relations between bleeding and outcomes in patients with ST-elevation myocardial infarction in the ExTRACT-TIMI 25 trial.
OBJECTIVE
To evaluate the association of bleeding with mortality in ST-elevation myocardial infarction (STEMI).


RESULTS
We studied 20 323 patients with STEMI receiving fibrinolytic therapy and an antithrombin in ExTRACT-TIMI 25. Relationships between in-hospital bleeding, patient characteristics, treatments, and in-hospital cardiovascular complications with mortality were evaluated using Cox models. Likelihood ratios estimated each variable's model contribution. High 30-day mortality after major bleeding (n = 309, 37.6% mortality) was driven by the poor prognosis of intracranial haemorrhage (ICH; n = 143, 65.4% mortality, model contribution 7.8%). The adjusted hazard ratios (HRs) for 30-day death for any major bleeding and for ICH were 2.9 [2.4-3.6] and 10.3 [8.2-12.8], respectively. Neither non-ICH major nor minor bleeding was associated with 30-day death after adjustment. Cardiogenic shock (HR 13.5, 61% contribution) and age (HR 1.6/decade, 17% contribution) were most strongly correlated with 30-day death. Among 30-day survivors, age (HR 1.6/decade, contribution 43%) and heart rate (HR 1.2 per 10 b.p.m., contribution 18%) were most strongly associated with mortality between Days 31 and 365.


CONCLUSIONS
Cardiogenic shock, age, and ICH were important independent correlates of 30-day and 1-year mortality in STEMI patients receiving fibrinolytic therapy. In-hospital non-ICH major and minor bleeding were not independently associated with increased mortality at 30 days or 1 year.
Giugliano
Robert P
RP
Cardiovascular Medicine, TIMI Study Group, Brigham and Women's Hospital, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA. rgiugliano@partners.org
Giraldez
Roberto R
RR
Morrow
David A
DA
Antman
Elliott M
EM
Gibson
C Michael
CM
Mohanavelu
Satishkumar
S
Murphy
Sabina A
SA
McCabe
Carolyn H
CH
Braunwald
Eugene
E
D000368:Aged; D002423:Cause of Death; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D012008:Recurrence; D012770:Shock, Cardiogenic / Q000401:mortality; D016896:Treatment Outcome
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin