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Meta-Analysis
. 2021 Sep 20;17(7):550-560.
doi: 10.4244/EIJ-D-20-01197.

Mortality after bleeding versus myocardial infarction in coronary artery disease: a systematic review and meta-analysis

Raffaele Piccolo  1 , Angelo Oliva, Marisa Avvedimento, Anna Franzone, Stephan Windecker, Marco Valgimigli, Giovanni Esposito, Peter Jüni
Affiliations
Meta-Analysis

Mortality after bleeding versus myocardial infarction in coronary artery disease: a systematic review and meta-analysis

Raffaele Piccolo et al. EuroIntervention. .

Abstract

Background: Bleeding is the principal safety concern of antithrombotic therapy and occurs frequently among patients with coronary artery disease (CAD).

Aims: We aimed to evaluate the prognostic impact of bleeding on mortality compared with that of myocardial infarction (MI) in patients with CAD.

Methods: We searched Medline and Embase for studies that included patients with CAD and that reported both the association between the occurrence of bleeding and mortality, and between the occurrence of MI and mortality within the same population. Adjusted hazard ratios (HRs) for mortality associated with bleeding and MI were extracted and ratios of hazard ratios (rHRs) were pooled by using inverse variance weighted random effects meta-analyses. Early events included periprocedural or within 30-day events after revascularisation or acute coronary syndrome (ACS). Late events included spontaneous or beyond 30-day events after revascularisation or ACS.

Results: A total of 141,059 patients were included across 16 studies; 128,660 (91%) underwent percutaneous coronary intervention. Major bleeding increased the risk of mortality to the same extent as MI (rHRsbleedingvsMI 1.10, 95% CI: 0.71-1.71, p=0.668). Early bleeding was associated with a higher risk of mortality than early MI (rHRsbleedingvsMI 1.46, 95% CI: 1.13-1.89, p=0.004), although this finding was not present when only randomised trials were included. Late bleeding was prognostically comparable to late MI (rHRsbleedingvsMI 1.14, 95% CI: 0.87-1.49, p=0.358).

Conclusions: Compared with MI, major and late bleeding is associated with a similar increase in mortality, whereas early bleeding might have a stronger association with mortality.

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Conflict of interest statement

R. Piccolo reports personal fees from Abbott Vascular. S. Windecker reports research and educational grants to the institution from Abbott, Amgen, BMS, Bayer, Boston Scientific, Biotronik, Cardinal Health, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Johnson&Johnson, Medtronic, Querbet, Polares, Sanofi, Terumo, and Sinomed. M. Valgimigli reports grants and personal fees from Terumo, personal fees from AstraZeneca, Alvimedica/CID, Abbott Vascular, Daiichi Sankyo, Opsens, Bayer, CoreFlow, Idorsia Pharmaceuticals Ltd, Universität Basel Dept. Klinische Forschung, Vifor, Bristol Myers Squibb SA, iVascular, and Medscape. P. Jüni serves as unpaid member of the steering group of trials funded by AstraZeneca, Biotronik, Biosensors, St. Jude Medical and The Medicines Company, has received research grants to the institution from AstraZeneca, Biotronik, Biosensors International, Eli Lilly and The Medicines Company, and honoraria to the institution for participation in advisory boards and/or consulting from Amgen, Ava and Fresenius, but has not received personal payments by any pharmaceutical company or device manufacturer, and he has no other relationships or activities that could appear to have influenced the submitted work. The other authors have no conflicts of interest to declare.

Figures

Central illustration
Central illustration
Association between bleeding and myocardial infarction with mortality for early events, late events and early or late events.
Figure 1
Figure 1
Association of bleeding and myocardial infarction with mortality in patients with coronary artery disease treated with medical therapy or percutaneous coronary intervention.
Figure 2
Figure 2
Adjusted hazard ratios for all-cause mortality for patients with early or late events. HRs for bleeding are for major bleeding. *Refers to Stone et al 2013.
Figure 3
Figure 3
Adjusted hazard ratios for all-cause mortality for patients with early events. HRs for bleeding are for major bleeding.
Figure 4
Figure 4
Adjusted hazard ratios for all-cause mortality for patients with late events. HRs for bleeding are for major bleeding.
Figure 5
Figure 5
Adjusted hazard ratios for all-cause mortality for patients with late minor bleeding. HRs for bleeding are for minor bleeding.
See this image and copyright information in PMC

Comment in

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