Impact of Major Bleeding on 30-Day Mortality and Clinical Outcomes in Patients With Acute Coronary Syndromes

• Published in: Journal of the American College of Cardiology Vol. 49; no. 12; pp. 1362 - 1368
• Main Authors: Manoukian, Steven V., MD, FACC, Feit, Frederick, MD, FACC, Mehran, Roxana, MD, FACC, Voeltz, Michele D., MD, Ebrahimi, Ramin, MD, FACC, Hamon, Martial, MD, Dangas, George D., MD, PhD, FACC, Lincoff, A. Michael, MD, FACC, White, Harvey D., DSc, FACC, Moses, Jeffrey W., MD, FACC, King, Spencer B., MD, MACC, Ohman, E. Magnus, MD, FACC, Stone, Gregg W., MD, FACC
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 27.03.2007
• Subjects: Cardiovascular; Internal Medicine; coronary artery bypass graft surgery; ACS; GPI; percutaneous coronary intervention; GRACE; Global Registry of Acute Coronary Events; myocardial infarction; PCI; glycoprotein IIb/IIIa inhibitor/inhibition; CABG; MI; acute coronary syndromes
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2007.02.027

Impact of Major Bleeding on 30-Day Mortality and Clinical Outcomes in Patients With Acute Coronary Syndromes: An Analysis From the ACUITY Trial Steven V. Manoukian, Frederick Feit, Roxana Mehran, Michele D. Voeltz, Ramin Ebrahimi, Martial Hamon, George D. Dangas, A. Michael Lincoff, Harvey D. White, Jeffrey W. Moses, Spencer B. King III, E. Magnus Ohman, Gregg W. Stone The predictors of major bleeding and its impact on 30-day mortality in 13,819 patients with acute coronary syndromes (ACS) undergoing an early invasive strategy were assessed. Major bleeding occurred in 4.7% of patients and was less frequent with the use of bivalirudin monotherapy versus heparin (unfractionated or enoxaparin) plus glycoprotein IIb/IIIa inhibition (3.0% vs. 5.7%, p < 0.0001). Several factors were independent predictors of major bleeding, including treatment with heparin plus glycoprotein IIb/IIIa inhibition. Major bleeding was a powerful independent predictor of 30-day mortality (odds ratio 7.55, 95% confidence interval 4.68 to 12.18, p < 0.0001). Reducing bleeding risk might improve outcomes in ACS.