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Impact of bleeding on mortality in patients with acute myocardial infarction complicated by cardiogenic shock

2021; Oxford University Press; Volume: 10; Issue: 4 Linguagem: Inglês

10.1093/ehjacc/zuab014

2048-8734

Kensaku Nishihira, Satoshi Honda, Misa Takegami, Sunao Kojima, Yasuhide Asaumi, Makoto Suzuki, Masami Kosuge, Jun Takahashi, Yasuhiko Sakata, Morimasa Takayama, Tetsuya Sumiyoshi, Hisao Ogawa, Kazuo Kimura, Satoshi Yasuda, Takashi Takenaka, Hirofumi Tomita, Hiroaki Yokoyama, Tomonori Ito, Masaru Ishida, Yorihiko Koeda, Masafumi Watanabe, Tetsu Watanabe, Taku Toshima, Hiroaki Shimokawa, Yasuhiko Sakata, Jun Takahashi, Kiyotaka Hao, Tetsuya Sumiyoshi, Morimasa Takayama, Kazuo Kimura, Masami Kosuge, Toshiaki Ebina, Hiroshi Suzuki, Atsuo Maeda, Masaaki Ito, Tairo Kurita, Jun Masuda, Takashi Tanigawa, Jitsuo Higaki, Kazuhisa Nishimura, Naohiko Takahashi, Hidefumi Akioka, Kyoko Kawano, Koji Maemura, Yuji Koide, Sunao Kojima, Kenichi Tsujita, Hisao Ogawa, Satoshi Yasuda, Yasuhide Asaumi, Kensaku Nishihira, Yoshihiro Miyamoto, Misa Takegami, Satoshi Honda, Hiroshi Nakajima, Kenji Yamaguchi, Takao Makino, Daitarou Kanno, Y Omoto, Daisuke Hotta, Toshiya Sato, Naoki Sato, Arifumi Kikuchi, Michiko Sone, Koji Takagi, Imun Tei, Takashi Shibui, Sho Nagamine, Wataru Shimizu, Takeshi Yamamoto, T. Takahashi, Yukihiko Momiyama, Atsushi Mizuno, Hiroshi Ohira, Hideaki Yoshino, Youhei Shigeta, Atsushi Hirayama, Yasuo Okumura, Daisuke Fukamachi, Tadateru Takayama, Hiroki Niikura, Hiroki Takenaka, Shuzo Tanimoto, Kazuyuki Yahagi, Hiroyuki Tanaka, Yasuhiro Sato, Masakazu Ohno, Takamichi Miyamoto, Nobuhiro Hara, Mikio Kishi, Shigeo Shimizu, Ken Kurihara, Yasuhiro Ishii, Ken Kozuma, Yusuke Watanabe, Yasuhiro Takahashi, Michihiro Yoshimura, Satoshi Morimoto, Nobuhisa Hagiwara, Yuichiro Minami, Jun Yamashita, Kaoru Iwabuchi, Takeshi Yamauchi, Atsushi Kato, Shigeto Namiuchi, Tsuyoshi Shinozaki, Kazunori Ogata, Ryuji Tsuburaya,

Cardiac Structural Anomalies and Repair

Abstract Aims Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with substantial mortality, although there are limited data available on bleeding in this critical condition. This study sought to investigate the incidence and impact of major in-hospital bleeding on all-cause mortality in patients with AMICS who undergo percutaneous coronary intervention (PCI). Methods and results Between 2015 and 2017, a total of 3411 patients hospitalized within 24 h after symptom onset were prospectively enrolled in the Japan Acute Myocardial Infarction Registry (JAMIR) and followed up for a median of 293 (interquartile range, 22–375) days. AMICS developed in 335 (9.8%) patients (mean age, 71.3 ± 13.6 years). Overall, the rate of major in-hospital bleeding (Bleeding Academic Research Consortium types 3 and 5) and in-hospital mortality was 14.6% and 28.7%, respectively. The majority of major in-hospital bleeding (73.5%) occurred within 48 h after PCI. Compared to patients without major in-hospital bleeding, those with it had higher rates of renal failure, left main coronary artery culprit lesion, and intra-aortic balloon pump or extracorporeal membrane oxygenation support, and had longer door-to-device time. The cumulative incidence of 1-year all-cause mortality was significantly higher in the major bleeding group compared to the non-major bleeding group (63.8% vs. 25.5%; log-rank P < 0.001). After adjusting for confounders, major in-hospital bleeding was independently associated with increased all-cause mortality (hazard ratio, 1.70; 95% confidence interval, 1.08–2.69). Conclusions These findings of JAMIR indicate that major in-hospital bleeding is associated with all-cause mortality in patients with AMICS who undergo PCI.