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  • Marquis-Gravel, GuillaumeDuke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA. (author)

Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • Elsevier BV,2020
  • printrdacarrier

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  • LIBRIS-ID:oai:DiVA.org:uu-419795
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-419795URI
  • https://doi.org/10.1016/j.jacc.2020.05.031DOI

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  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

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  • BACKGROUND The long-term prognostic impact of post-discharge bleeding in the unique population of patients with acute coronary syndrome (ACS) treated without percutaneous coronary intervention (PCI) remains unexplored.OBJECTIVES The aim of this study was to assess the association between post-discharge bleeding and subsequent mortality after ACS according to index strategy (PCI or no PCI) and to contrast with the association between post-discharge myocardial infarction (MI) and subsequent mortality.METHODS In a harmonized dataset of 4 multicenter randomized trials (APPRAISE-2 [Apixaban for Prevention of Acute Ischemic Events-2], PLATO [Study of Platelet Inhibition and Patient Outcomes], TRACER [Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome], and TRILOGY ACS [Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes]), the association between post-discharge noncoronary artery bypass graft-related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) moderate, severe, or life-threatening bleeding (landmark 7 days post-ACS) and subsequent all-cause mortality was evaluated in a time-updated Cox proportional hazards analysis. Interaction with index treatment strategy was assessed. Results were contrasted with risk for mortality following post-discharge MI.RESULTS Among 45,011 participants, 1,133 experienced post-discharge bleeding events (2.6 per 100 patient-years), and 2,149 died during follow-up. The risk for mortality was significantly higher <30 days (adjusted hazard ratio: 15.7; 95% confidence interval: 12.3 to 20.0) and 30 days to 12 months (adjusted hazard ratio: 2.7; 95% confidence interval: 2.1 to 3.4) after bleeding, and this association was consistent in participants treated with or without PCI for their index ACS (p for interaction = 0.240). The time-related association between post-discharge bleeding and mortality was similar to the association between MI and subsequent mortality in participants treated with and without PCI (p for interaction = 0.696).CONCLUSIONS Post-discharge bleeding after ACS is associated with a similar increase in subsequent all-cause mortality in participants treated with or without PCI and has an equivalent prognostic impact as post-discharge MI.

Subject headings and genre

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  • Dalgaard, FrederikDuke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA. (author)
  • Jones, Aaron D.Duke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA. (author)
  • Lokhnygina, YuliyaDuke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA. (author)
  • James, Stefan,1964-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)stjam367 (author)
  • Harrington, Robert A.Stanford Univ, Dept Med, Stanford, CA 94305 USA. (author)
  • Wallentin, Lars,1943-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (author)
  • Steg, Philippe GabrielUniv Paris, AP HP, Paris, France.;INSERM U1148, Paris, France.;Imperial Coll, Royal Brompton Hosp, London, England. (author)
  • Lopes, Renato D.Duke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA.;Duke Univ, Sch Med, Div Cardiol, Durham, NC 27708 USA. (author)
  • Storey, Robert F.Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England. (author)
  • Goodman, Shaun G.Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada.;Univ Toronto, St Michaels Hosp, Toronto, ON, Canada. (author)
  • Mahaffey, Kenneth W.Stanford Sch Med, Dept Med, Stanford Ctr Clin Res, Palo Alto, CA USA. (author)
  • Tricoci, PierluigiCSL Behring, Durham, NC USA. (author)
  • White, Harvey D.Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand. (author)
  • Armstrong, Paul W.Univ Alberta, Canadian VIGOUR Ctr, Edmonton, AB, Canada.;Univ Alberta, Div Cardiol, Edmonton, AB, Canada. (author)
  • Ohman, E. MagnusDuke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA.;Duke Univ, Sch Med, Div Cardiol, Durham, NC 27708 USA. (author)
  • Alexander, John H.Duke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA.;Duke Univ, Sch Med, Div Cardiol, Durham, NC 27708 USA. (author)
  • Roe, Matthew T.Duke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA.;Duke Univ, Sch Med, Div Cardiol, Durham, NC 27708 USA. (author)
  • Duke Clin Res Inst, 200 Morris St,Room 7410, Durham, NC 27701 USA.Kardiologi (creator_code:org_t)

Related titles

  • In:Journal of the American College of Cardiology: Elsevier BV76:2, s. 162-1710735-10971558-3597

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