High Bleeding Incidence in Unselected Hospitalized Suspected Non–ST-Segment Elevation Myocardial Infarction Patients Aged Under 65 Years
•Although the prevalence of high bleeding risk (HBR) was nearly 50%, overall bleeding incidence was low.•No significant difference in bleeding incidence was found between HBR and non-HBR.•Surprisingly, the highest bleeding incidence was observed in patients
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| Veröffentlicht in: | The American journal of cardiology 2023-11, Vol.206, p.101-104 |
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| container_title | The American journal of cardiology |
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| creator | Kesti, Henri Mäkinen, Henna Mattila, Kalle Jaakkola, Samuli Lintu, Mikko Porela, Pekka |
| description | •Although the prevalence of high bleeding risk (HBR) was nearly 50%, overall bleeding incidence was low.•No significant difference in bleeding incidence was found between HBR and non-HBR.•Surprisingly, the highest bleeding incidence was observed in patients |
| doi_str_mv | 10.1016/j.amjcard.2023.08.102 |
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High bleeding risk (HBR) is commonly encountered among patients with acute coronary syndrome (ACS), and bleeding complications are associated with worse prognosis. Data on bleeding events of patients with ACS are based almost exclusively on percutaneous coronary intervention registries. Enrolling only patients suitable for invasive procedures might have skewed the observed bleeding incidence. We sought to investigate bleeding incidence in unselected patients with ACS. Patients were retrospectively enrolled between January and June 2019 from the emergency department of a tertiary hospital. All consecutive hospitalized adults with suspected non–ST-segment elevation myocardial infarction were included. Data was gathered by a database search and verified using electronic patient records. Bleeding risk was assessed according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) definition. The primary end point was a composite of post- discharge Bleeding Academic Research Consortium type 2, 3, and 5 bleeding during 1-year follow-up. Of the 209 included patients, 15 (7.2%) suffered a bleeding event. There were more bleeding events among dual antiplatelet therapy (DAPT) users as compared with those without DAPT (10.7% vs 3.1%, p = 0.033). Among HBR patients, 6.1% and in non-HBR patients 8.1% suffered a bleeding event (p = 0.579). Notably, major bleeding (Bleeding Academic Research Consortium type 3) incidence was highest in patients <65 years and without DAPT use. In conclusion, unselected suspected non–ST-segment elevation myocardial infarction patients aged <65 years had surprisingly high bleeding incidence, regardless of ARC-HBR status or DAPT use.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2023.08.102</identifier><language>eng</language><publisher>New York: Elsevier Inc</publisher><subject>acute coronary syndrome ; Acute coronary syndromes ; Age groups ; Antiplatelet therapy ; Bleeding ; Complications ; Consortia ; dual anti-platelet therapy ; Editing ; Emergency medical care ; Emergency medical services ; Heart attacks ; hemorrhage ; Hospitalization ; Medical imaging ; Myocardial infarction ; non–ST-elevated myocardial infarction ; Patients ; Segments ; Visualization ; Writing</subject><ispartof>The American journal of cardiology, 2023-11, Vol.206, p.101-104</ispartof><rights>2023 The Authors</rights><rights>2023. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2802-72d50594fd0ba63b9c6a9724a5af255937ae632ff5d1babcafed43a7b623ce123</cites><orcidid>0000-0003-1207-2362</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914923008615$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids></links><search><creatorcontrib>Kesti, Henri</creatorcontrib><creatorcontrib>Mäkinen, Henna</creatorcontrib><creatorcontrib>Mattila, Kalle</creatorcontrib><creatorcontrib>Jaakkola, Samuli</creatorcontrib><creatorcontrib>Lintu, Mikko</creatorcontrib><creatorcontrib>Porela, Pekka</creatorcontrib><title>High Bleeding Incidence in Unselected Hospitalized Suspected Non–ST-Segment Elevation Myocardial Infarction Patients Aged Under 65 Years</title><title>The American journal of cardiology</title><description>•Although the prevalence of high bleeding risk (HBR) was nearly 50%, overall bleeding incidence was low.•No significant difference in bleeding incidence was found between HBR and non-HBR.•Surprisingly, the highest bleeding incidence was observed in patients <65 years.•Bleeding Academic Research Consortium type 3 bleeding incidence was highest in patients <65 years and without dual antiplatelet therapy use.
High bleeding risk (HBR) is commonly encountered among patients with acute coronary syndrome (ACS), and bleeding complications are associated with worse prognosis. Data on bleeding events of patients with ACS are based almost exclusively on percutaneous coronary intervention registries. Enrolling only patients suitable for invasive procedures might have skewed the observed bleeding incidence. We sought to investigate bleeding incidence in unselected patients with ACS. Patients were retrospectively enrolled between January and June 2019 from the emergency department of a tertiary hospital. All consecutive hospitalized adults with suspected non–ST-segment elevation myocardial infarction were included. Data was gathered by a database search and verified using electronic patient records. Bleeding risk was assessed according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) definition. The primary end point was a composite of post- discharge Bleeding Academic Research Consortium type 2, 3, and 5 bleeding during 1-year follow-up. Of the 209 included patients, 15 (7.2%) suffered a bleeding event. There were more bleeding events among dual antiplatelet therapy (DAPT) users as compared with those without DAPT (10.7% vs 3.1%, p = 0.033). Among HBR patients, 6.1% and in non-HBR patients 8.1% suffered a bleeding event (p = 0.579). Notably, major bleeding (Bleeding Academic Research Consortium type 3) incidence was highest in patients <65 years and without DAPT use. In conclusion, unselected suspected non–ST-segment elevation myocardial infarction patients aged <65 years had surprisingly high bleeding incidence, regardless of ARC-HBR status or DAPT use.</description><subject>acute coronary syndrome</subject><subject>Acute coronary syndromes</subject><subject>Age groups</subject><subject>Antiplatelet therapy</subject><subject>Bleeding</subject><subject>Complications</subject><subject>Consortia</subject><subject>dual anti-platelet therapy</subject><subject>Editing</subject><subject>Emergency medical care</subject><subject>Emergency medical services</subject><subject>Heart attacks</subject><subject>hemorrhage</subject><subject>Hospitalization</subject><subject>Medical imaging</subject><subject>Myocardial infarction</subject><subject>non–ST-elevated myocardial infarction</subject><subject>Patients</subject><subject>Segments</subject><subject>Visualization</subject><subject>Writing</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFUU1vEzEQtRBIDYGfUMkSFy4b_BHvrk-oVC2p1NJKaQ6crFl7Nni18QZ7U6mcOHPlH_JL6iU9ceE0mjfvjd7MI-SUswVnvPzQLWDXWYhuIZiQC1ZnWLwgM15XuuCay5dkxhgTheZLfUJep9TllnNVzsivld9-o596ROfDll4F6x0Gi9QHugkJe7QjOroa0t6P0PsfuVkf0v4IfxnCn5-_1_fFGrc7DCO96PEBRj8EevM4TJY89HlpC9H-Re_yMPMSPdtm-SY4jLRU9CtCTG_Iqxb6hG-f65xsLi_uz1fF9e3nq_Oz68KKOh9RCaeY0svWsQZK2Whbgq7EEhS0QiktK8BSirZVjjfQWGjRLSVUTSmkRS7knLw_7t3H4fsB02h2Plnsewg4HJIRdZZrJXOZk3f_ULvhEEN2l1mVrEqmucosdWTZOKQUsTX76HcQHw1nZkrIdOY5ITMlZFid4cnIx6MO87UPHqNJ1k_Pdz7m_xo3-P9seAL5NZ40</recordid><startdate>20231101</startdate><enddate>20231101</enddate><creator>Kesti, Henri</creator><creator>Mäkinen, Henna</creator><creator>Mattila, Kalle</creator><creator>Jaakkola, Samuli</creator><creator>Lintu, Mikko</creator><creator>Porela, Pekka</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1207-2362</orcidid></search><sort><creationdate>20231101</creationdate><title>High Bleeding Incidence in Unselected Hospitalized Suspected Non–ST-Segment Elevation Myocardial Infarction Patients Aged Under 65 Years</title><author>Kesti, Henri ; 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High bleeding risk (HBR) is commonly encountered among patients with acute coronary syndrome (ACS), and bleeding complications are associated with worse prognosis. Data on bleeding events of patients with ACS are based almost exclusively on percutaneous coronary intervention registries. Enrolling only patients suitable for invasive procedures might have skewed the observed bleeding incidence. We sought to investigate bleeding incidence in unselected patients with ACS. Patients were retrospectively enrolled between January and June 2019 from the emergency department of a tertiary hospital. All consecutive hospitalized adults with suspected non–ST-segment elevation myocardial infarction were included. Data was gathered by a database search and verified using electronic patient records. Bleeding risk was assessed according to the Academic Research Consortium for High Bleeding Risk (ARC-HBR) definition. The primary end point was a composite of post- discharge Bleeding Academic Research Consortium type 2, 3, and 5 bleeding during 1-year follow-up. Of the 209 included patients, 15 (7.2%) suffered a bleeding event. There were more bleeding events among dual antiplatelet therapy (DAPT) users as compared with those without DAPT (10.7% vs 3.1%, p = 0.033). Among HBR patients, 6.1% and in non-HBR patients 8.1% suffered a bleeding event (p = 0.579). Notably, major bleeding (Bleeding Academic Research Consortium type 3) incidence was highest in patients <65 years and without DAPT use. In conclusion, unselected suspected non–ST-segment elevation myocardial infarction patients aged <65 years had surprisingly high bleeding incidence, regardless of ARC-HBR status or DAPT use.</abstract><cop>New York</cop><pub>Elsevier Inc</pub><doi>10.1016/j.amjcard.2023.08.102</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0003-1207-2362</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | acute coronary syndrome Acute coronary syndromes Age groups Antiplatelet therapy Bleeding Complications Consortia dual anti-platelet therapy Editing Emergency medical care Emergency medical services Heart attacks hemorrhage Hospitalization Medical imaging Myocardial infarction non–ST-elevated myocardial infarction Patients Segments Visualization Writing |
| title | High Bleeding Incidence in Unselected Hospitalized Suspected Non–ST-Segment Elevation Myocardial Infarction Patients Aged Under 65 Years |
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