18
IRUS TotalDownloads
Altmetric
Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events.
File | Description | Size | Format | |
---|---|---|---|---|
Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events..pdf | Published version | 301.69 kB | Adobe PDF | View/Open |
Title: | Has the frequency of bleeding changed over time for patients presenting with an acute coronary syndrome? The global registry of acute coronary events. |
Authors: | Fox, KA Carruthers, K Steg, PG Avezum, A Granger, CB Montalescot, G Goodman, SG Gore, JM Quill, AL Eagle, KA GRACE Investigators, |
Item Type: | Journal Article |
Abstract: | AIMS: To determine whether changes in practice, over time, are associated with altered rates of major bleeding in acute coronary syndromes (ACS). METHODS AND RESULTS: 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. CONCLUSION: 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. |
Issue Date: | 2-Mar-2010 |
URI: | http://hdl.handle.net/10044/1/15465 |
DOI: | http://dx.doi.org/10.1093/eurheartj/ehp499 |
Start Page: | 667 |
End Page: | 675 |
Journal / Book Title: | Eur Heart J |
Volume: | 31 |
Issue: | 6 |
Copyright Statement: | Published on behalf of the European Society of Cardiology. All rights reserved. ©The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org. The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org |
Conference Place: | England |
Appears in Collections: | National Heart and Lung Institute |