Incidence, Predictors, and Outcome of In-Hospital Bleeding in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction

• Published in: The American journal of cardiology Vol. 144; pp. 13 - 19
• Main Authors: Ratcovich, Hanna, Josiassen, Jakob, Helgestad, Ole K.L., Linde, Louise, Sadjadieh, Golnaz, Engstrøm, Thomas, Jensen, Lisette O., Ravn, Hanne B., Schmidt, Henrik, Hassager, Christian, Møller, Jacob E., Holmvang, Lene
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2021; Elsevier Limited
• Subjects: Acute Kidney Injury - epidemiology; Aged; Aged, 80 and over; Bleeding; Blood pressure; Classification; Complications; Confidence intervals; Consortia; Extracorporeal Membrane Oxygenation; Female; Health hazards; Heart attacks; Heart surgery; Heart-Assist Devices - statistics & numerical data; Hemodynamics; Hemoglobin; Hemorrhage - epidemiology; Hemorrhage - therapy; Hospital Mortality; Hospitalization; Humans; Incidence; Intensive care; Intensive Care Units; Intra-Aortic Balloon Pumping - statistics & numerical data; Kidneys; Lactic acid; Length of Stay; Male; Medical imaging; Medical records; Middle Aged; Morbidity; Mortality; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - therapy; Normal distribution; Patients; Percutaneous Coronary Intervention; Proportional Hazards Models; Risk Factors; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Denmark
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.12.045

Bleeding after acute myocardial infarction (AMI) is associated with an increased morbidity and mortality. The frequency and consequences of bleeding events in patients with AMICS are not well described. The objective was to investigate incidence and outcome of bleeding complications among unselected patients with AMI complicated by cardiogenic shock (AMICS) and referred for immediate revascularization. Bleeding events were assessed by review of medical records in consecutive AMICS patients admitted between 2010 and 2017. Bleedings during admission were classified according to Bleeding Academic Research Consortium classification. Patients who did not survive to admission in the intensive care unit were excluded. Of the 1,716 patients admitted with AMICS, 1,532 patients (89%) survived to ICU admission. At 30 days, mortality was 48%. Severe bleedings classified as BARC 3/5 were seen in 87 non-coronary bypass grafting patients (6.1%). Co-morbidity did not differ among patients; however, patients who had a BARC 3/5 bleeding had significantly higher lactate and lower systolic blood pressure at admission, indicating a more severe state of shock. The use of mechanical assist devices was significantly associated with severe bleeding events. Univariable analysis showed that patients with a BARC 3/5 bleeding had a significantly higher 30-day mortality hazard compared with patients without severe bleedings. The association did not sustain after multivariable adjustment (hazard ratio 0.90, 95% confidence interval 0.64; 1.26, p = 0.52). In conclusion, severe bleeding events according to BARC classification in an all-comer population of patients with AMICS were not associated with higher mortality when adjusting for immediate management, hemodynamic, and metabolic state. This indicates that mortality in these patients is primarily related to other factors.
•In an unselected cohort of patients with AMICS, severe bleedings occurred in 6.1%.•Bleedings were more common in patients with left ventricular assist devices.•Severe bleedings were not associated with higher mortality after multivariable adjustment.•Despite heavy instrumentation, <1% of patients suffered a fatal, nonsurgery-related bleeding.