Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The Global Registry of Acute Coronary Events

被引:54
作者
Fox, Keith A. A. [1 ]
Carruthers, Kathryn [1 ]
Steg, Ph. Gabriel [2 ]
Avezum, Alvaro [3 ]
Granger, Christopher B. [4 ]
Montalescot, Gilles [5 ]
Goodman, Shaun G. [6 ,7 ]
Gore, Joel M. [8 ]
Quill, Ann L. [8 ]
Eagle, Kim A. [9 ]
机构
[1] Univ Edinburgh, Div Med & Radiol Sci, Edinburgh, Midlothian, Scotland
[2] Univ Paris 07, INSERM, Dept Cardiol, AP HP,U698, Paris, France
[3] Dante Pazzanese Inst Cardiol, Sao Paulo, Brazil
[4] Duke Univ, Med Ctr, Durham, NC USA
[5] Hop La Pitie Salpetriere, Paris, France
[6] Univ Toronto, St Michaels Hosp, Div Cardiol, Canadian Heart Res Ctr, Toronto, ON M5B 1W8, Canada
[7] Univ Toronto, St Michaels Hosp, Div Cardiol, Terrence Donnelly Heart Ctr, Toronto, ON M5B 1W8, Canada
[8] Univ Massachusetts, Sch Med, Worcester, MA USA
[9] Univ Michigan Hlth Syst, Ann Arbor, MI USA
关键词
Acute coronary syndrome; Bleeding; Unstable angina; Myocardial infarction; ST-SEGMENT-ELEVATION; ACUTE MYOCARDIAL-INFARCTION; UNFRACTIONATED HEPARIN; CLINICAL-OUTCOMES; RANDOMIZED-TRIAL; ENOXAPARIN; MORTALITY; GRACE; FONDAPARINUX; IMPACT;
D O I
10.1093/eurheartj/ehp499
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To determine whether changes in practice, over time, are associated with altered rates of major bleeding in acute coronary syndromes (ACS). Patients from the Global Registry of Acute Coronary Events were enrolled between 2000 and 2007. The main outcome measures were frequency of major bleeding, including haemorrhagic stroke, over time, after adjustment for patient characteristics, and impact of major bleeding on death and myocardial infarction. Of the 50 947 patients, 2.3% sustained a major bleed; almost half of these presented with ST-elevation ACS (44%, 513). Despite changes in antithrombotic therapy (increasing use of low molecular weight heparin, P < 0.0001), thienopyridines (P < 0.0001), and percutaneous coronary interventions (P < 0.0001), frequency of major bleeding for all ACS patients decreased (2.6 to 1.8%; P < 0.0001). Most decline was seen in ST-elevation ACS (2.9 to 2.1%, P = 0.02). The overall decline remained after adjustment for patient characteristics and treatments (P = 0.002, hazard ratio 0.94 per year, 95% confidence interval 0.91-0.98). Hospital characteristics were an independent predictor of bleeding (P < 0.0001). Patients who experienced major bleeding were at increased risk of death within 30 days from admission, even after adjustment for baseline variables. Despite increasing use of more intensive therapies, there was a decline in the rate of major bleeding associated with changes in clinical practice. However, individual hospital characteristics remain an important determinant of the frequency of major bleeding.
引用
收藏
页码:667 / 675
页数:9
相关论文
共 20 条
[1]   Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project:: A multinational registry of patients hospitalized with acute coronary syndromes [J].
Agnelli, G ;
Avezum, A ;
Brieger, D ;
Budaj, A ;
Cannon, CP ;
Goldberg, RJ ;
Goodman, S ;
Gulba, DC ;
Granger, C ;
Kennelly, BM ;
Gurfinkel, E ;
López-Sendón, J ;
Klein, W ;
Montalescot, G ;
Van de Werf, F .
AMERICAN HEART JOURNAL, 2001, 141 (02) :190-199
[2]   Enoxaparin versus unfractionated heparin as antithrombin therapy in patients receiving fibrinolysis for ST-elevation myocardial infarction: Design and rationale for the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction study 25 (ExTRACT-TIMI 25) [J].
Antman, EM ;
Morrow, DA ;
McCabe, CH ;
Jiang, F ;
White, HD ;
Fox, KAA ;
Sharma, D ;
Chew, P ;
Braunwald, E .
AMERICAN HEART JOURNAL, 2005, 149 (02) :217-226
[3]  
Bassand JP, 2007, EUR HEART J, V28, P1598, DOI 10.1093/eurheartj/ehm161
[4]   Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction:: findings from the Global Registry of Acute Coronary Events (GRACE) [J].
Eagle, KA ;
Goodman, SG ;
Avezum, A ;
Budaj, A ;
Sullivan, CM ;
López-Sendón, J .
LANCET, 2002, 359 (9304) :373-377
[5]   Adverse impact of bleeding on prognosis in patients with acute coronary syndromes [J].
Eikelboom, John W. ;
Mehta, Shamir R. ;
Anand, Sonia S. ;
Xie, Changchun ;
Fox, Keith A. A. ;
Yusuf, Salim .
CIRCULATION, 2006, 114 (08) :774-782
[6]  
Ferguson JJ, 2004, JAMA-J AM MED ASSOC, V292, P45
[7]   Decline in rates of death and heart failure in acute coronary syndromes, 1999-2006 [J].
Fox, Keith A. A. ;
Steg, Philippe Gabriel ;
Eagle, Kim A. ;
Goodman, Shaun G. ;
Anderson, Frederick A., Jr. ;
Granger, Christopher B. ;
Flather, Marcus D. ;
Budaj, Andrzej ;
Quill, Ann ;
Gore, Joel M. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2007, 297 (17) :1892-1900
[8]   Predictors of hospital mortality in the global registry of acute coronary events [J].
Granger, CB ;
Goldberg, RJ ;
Dabbous, O ;
Pieper, KS ;
Eagle, KA ;
Cannon, CP ;
Van de Werf, F ;
Avezum, A ;
Goodman, SG ;
Flather, MD ;
Fox, KAA .
ARCHIVES OF INTERNAL MEDICINE, 2003, 163 (19) :2345-2353
[9]   Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes - An analysis from the ACUITY trial [J].
Manoukian, Steven V. ;
Feit, Frederick ;
Mehran, Roxana ;
Voeltz, Michele D. ;
Ebrahimi, Ramin ;
Hamon, Martial ;
Dangas, George D. ;
Lincoff, A. Michael ;
White, Harvey D. ;
Moses, Jefrey W. ;
King, Spencer B., III ;
Ohman, E. Magnus ;
Stone, Gregg W. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 49 (12) :1362-1368
[10]   Efficacy and safety of fondaparinux versus Enoxaparin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: Results from the OASIS-5 trial [J].
Mehta, Shamir R. ;
Granger, Christopher B. ;
Eikelboom, John W. ;
Bassand, Jean-Pierre ;
Wallentin, Lars ;
Faxon, David P. ;
Peters, Ron J. G. ;
Budaj, Andrzej ;
Afzal, Rizwan ;
Chrolavicius, Susan ;
Fox, Keith A. A. ;
Yusuf, Salim .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2007, 50 (18) :1742-1751