Impact of In-Hospital Bleeding on Postdischarge Therapies and Prognosis in Acute Coronary Syndromes

Acute coronary syndromes (ACS) continue to pose significant challenges for clinical practitioners, particularly regarding the prediction of mid- to long-term outcomes. This study aims to investigate the impact of in-hospital bleeding (IHB) at 1-year follow-up in patients admitted for ACS. Data from 23,270 patients enrolled in the international PRAISE registry and discharged after ACS were analyzed. A total of 1060 patients experienced IHB, whereas 18,765 did not; 3445 were excluded because of missing data. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included major bleeding, reinfarction, and composite endpoints at 1 year. Patients with IHB were older, more frequently female, and had a higher prevalence of cardiovascular risk factors (all P < 0.05). At discharge, IHB patients were less likely to receive optimal medical therapy. At the 1-year follow-up, all-cause mortality, major bleeding, and reinfarction were significantly higher in the IHB group (all P s < 0.001). Bivariate analysis showed a strong association between IHB and all the outcomes of interest (all odds ratios >1; all P s < 0.001). These associations remained significant even after adjusting for several covariates, except for reinfarction (odds ratio 1.3; 95% confidence interval 0.9-2.11; P = 0.149). Age, female sex, hypertension, and peripheral artery disease were found to be independent predictors of IHB, whereas drug-eluting stent implantation, radial access, and left ventricular ejection fraction were identified as protective factors. IHB is a hallmark of frailty in patients with ACS; therefore, greater attention should be given during follow-up to patients experiencing this condition.

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Publication Details

Journal
Journal of Cardiovascular Pharmacology
Published
2025-02-10
DOI
https://doi.org/10.1097/fjc.0000000000001678
Citations
27
Primary Topic
Acute Myocardial Infarction Research
Type
article
Field-Weighted Citation Impact
37.48
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article

Impact of In-Hospital Bleeding on Postdischarge Therapies and Prognosis in Acute Coronary Syndromes

Carlos Collet, Stefano Cacciatore, Luigi Spadafora, Federico Russo et al.
27 citations
Journal of Cardiovascular Pharmacology
Acute Myocardial Infarction Research
37.48
article

Impact of In-Hospital Bleeding on Postdischarge Therapies and Prognosis in Acute Coronary Syndromes

Carlos Collet, Stefano Cacciatore, Luigi Spadafora, Federico Russo, Nicola Pierucci, Gianmarco Sarto, Matteo Betti, Ovidio De Filippo, Alberto Testa, Fabrizio D’Ascenzo, Carlo Zivelonghi, Gaetano Maria De Ferrari, Marco Bernardi, Carlo Gaudio, Pierfrancesco Agostoni, Erica Rocco, Giuseppe Biondi‐Zoccai, Salvatore Giordano, Pierre François Sabouret, Beatrice Simeone, Bianca Pernice
article en
27 citations

Abstract

Acute coronary syndromes (ACS) continue to pose significant challenges for clinical practitioners, particularly regarding the prediction of mid- to long-term outcomes. This study aims to investigate the impact of in-hospital bleeding (IHB) at 1-year follow-up in patients admitted for ACS. Data from 23,270 patients enrolled in the international PRAISE registry and discharged after ACS were analyzed. A total of 1060 patients experienced IHB, whereas 18,765 did not; 3445 were excluded because of missing data. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included major bleeding, reinfarction, and composite endpoints at 1 year. Patients with IHB were older, more frequently female, and had a higher prevalence of cardiovascular risk factors (all P < 0.05). At discharge, IHB patients were less likely to receive optimal medical therapy. At the 1-year follow-up, all-cause mortality, major bleeding, and reinfarction were significantly higher in the IHB group (all P s < 0.001). Bivariate analysis showed a strong association between IHB and all the outcomes of interest (all odds ratios >1; all P s < 0.001). These associations remained significant even after adjusting for several covariates, except for reinfarction (odds ratio 1.3; 95% confidence interval 0.9-2.11; P = 0.149). Age, female sex, hypertension, and peripheral artery disease were found to be independent predictors of IHB, whereas drug-eluting stent implantation, radial access, and left ventricular ejection fraction were identified as protective factors. IHB is a hallmark of frailty in patients with ACS; therefore, greater attention should be given during follow-up to patients experiencing this condition.

Journal of Cardiovascular PharmacologyVol. 85(5)
Università Cattolica del Sacro Cuore (IT), University of Milan (IT), Agostino Gemelli University Polyclinic (IT), Magna Graecia University (IT), Sorbonne Université (FR), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Maria Cecilia Hospital (IT), Onze Lieve Vrouwziekenhuis Hospital (BE), Institut de Myologie (FR), Pitié-Salpêtrière Hospital (FR), Azienda Ospedaliera Sant'Andrea (IT), Société Française de Cardiologie (FR), Ziekenhuisnetwerk Antwerpen Stuivenberg (BE), Sapienza University of Rome (IT)
Good health and well-being
Openalex Percentile: Top 0%
Acute Myocardial Infarction Research
37.48
DOISourceOpenAlex
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