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Temporal trends in bleeding events in acutemyocardial infarction : Insights from the SWEDEHEARTregistry

Simonsson, Moa ; LarsWallentin, L. ; Alfredsson, Joakim ; Erlinge, David LU orcid ; Angerud, Karin Hellstrom ; Hofmann, Robin ; Kellerth, Thomas ; Lindhagen, Lars ; Ravn-Fischer, Annica and Szummer, Karolina , et al. (2020) In European Heart Journal 41(7). p.833-843
Abstract

Aims To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population. Methods and results Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the... (More)

Aims To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population. Methods and results Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-ofhospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%. Conclusion During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute myocardial infarction, Bleeding, Registry, Temporal trends
in
European Heart Journal
volume
41
issue
7
pages
11 pages
publisher
Oxford University Press
external identifiers
  • scopus:85079356955
  • pmid:31504404
ISSN
0195-668X
DOI
10.1093/eurheartj/ehz593
language
English
LU publication?
yes
id
77966d44-0011-404c-9977-e792ed5f8e6f
date added to LUP
2020-12-18 12:35:01
date last changed
2024-06-13 02:29:44
@article{77966d44-0011-404c-9977-e792ed5f8e6f,
  abstract     = {{<p>Aims To describe the time trends of in-hospital and out-of-hospital bleeding parallel to the development of new treatments and ischaemic outcomes over the last 20 years in a nationwide myocardial infarction (MI) population. Methods and results Patients with acute MI (n = 371 431) enrolled in the SWEDEHEART registry from 1995 until May 2018 were selected and evaluated for in-hospital bleeding and out-of-hospital bleeding events at 1 year. In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006 and thereafter slightly decreased to a new plateau around 1.3% by the end of the study period. Out-of-hospital bleeding increased in a stepwise fashion from 2.5% to 3.5 % in the middle of the study period and to 4.8% at the end of the study period. The increase in both in-hospital and out-ofhospital bleeding was parallel to increasing use of invasive strategy and adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT), and potent DAPT, while the decrease in in-hospital bleeding from 2007 to 2010 was parallel to implementation of bleeding avoidance strategies. In-hospital re-infarction decreased from 2.8% to 0.6% and out-of-hospital MI decreased from 12.6% to 7.1%. The composite out-of-hospital MI, cardiovascular death, and stroke decreased in a similar fashion from 18.4% to 9.1%. Conclusion During the last 20 years, the introduction of invasive and more intense antithrombotic treatment has been associated with an increase in bleeding events but concomitant there has been a substantial greater reduction of ischaemic events including improved survival.</p>}},
  author       = {{Simonsson, Moa and LarsWallentin, L. and Alfredsson, Joakim and Erlinge, David and Angerud, Karin Hellstrom and Hofmann, Robin and Kellerth, Thomas and Lindhagen, Lars and Ravn-Fischer, Annica and Szummer, Karolina and Ueda, Peter and Yndigegn, Troels and Jernberg, Tomas}},
  issn         = {{0195-668X}},
  keywords     = {{Acute myocardial infarction; Bleeding; Registry; Temporal trends}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{833--843}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal}},
  title        = {{Temporal trends in bleeding events in acutemyocardial infarction : Insights from the SWEDEHEARTregistry}},
  url          = {{http://dx.doi.org/10.1093/eurheartj/ehz593}},
  doi          = {{10.1093/eurheartj/ehz593}},
  volume       = {{41}},
  year         = {{2020}},
}