Impact of major bleeding on long-term outcomes in patients with reduced left ventricular systolic function following acute myocardial infarction
J J Kim, B H Hwang, K Chang, J H Seung, K Y Lee, S Y Lee, E S KimAbstract
Background
Major bleeding is a clinically relevant complication in the setting of acute coronary syndromes. However, contemporary evidence regarding its prognostic implications in patients with reduced left ventricular (LV) systolic function after acute myocardial infarction (AMI) remains limited.
Methods
We prospectively enrolled consecutive AMI patients undergoing percutaneous coronary intervention from January 2004 to August 2014. Among them, 1,246 patients with reduced LV systolic function (LV ejection fraction <40% by echocardiography) were stratified according to the presence of major bleeding events during hospitalization. The primary outcome was long-term all-cause mortality.
Results
Median follow-up was 44.9 months (interquartile range, 10.7–75.3). Patients with major bleeding were older, whereas sex distribution and prevalence of diabetes, hypertension, and dyslipidemia were comparable between groups. Prescription rates of guideline-directed medical therapy at discharge—including beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, potent P2Y12 inhibitors, and statins—were similar. Major bleeding was associated with significantly higher all-cause mortality (67.9% vs. 44.0%). After multivariable adjustment, major bleeding remained an independent predictor of mortality (hazard ratio 1.91; 95% confidence interval 1.45–2.52; p<0.001).
Conclusion
In patients with reduced LV systolic function following AMI, major bleeding confers a substantially worse long-term prognosis independent of established clinical risk factors.For image description, please refer to the figure legend and surrounding text.