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Am Heart J. 2013 Oct;166(4):723-8. doi: 10.1016/j.ahj.2013.07.014. Epub 2013 Sep 5.

Association between bleeding and mortality among women and men with high-risk acute coronary syndromes: insights from the Early versus Delayed, Provisional Eptifibatide in Acute Coronary Syndromes (EARLY ACS) trial.

Author information

1
University of Alberta, Edmonton, Alberta, Canada. Electronic address: pkaul@ualberta.ca.

Abstract

BACKGROUND:

Female sex is an established risk factor for bleeding, which is an important safety end point in patients presenting with non-ST-segment elevation acute coronary syndromes (NSTE ACS). However, it is unknown whether the association between bleeding and mortality is modulated by sex in this patient population.

METHODS:

We examined the interaction between sex and bleeding and 30-day mortality outcomes among 2,975 women and 6,431 men with high-risk NSTE ACS enrolled in the EARLY ACS trial. The Global Utilization of Strategies to Open Occluded Arteries (GUSTO) criteria were used to identify moderate or severe bleeds.

RESULTS:

Women were older and had more comorbid disease compared with men. Bleeding rates were higher among women (8.2%) than among men (5.5%; P < .01). However, the association of bleeding and 30-day mortality was stronger among men (odds ratio 5.8, 95% CI 3.9-8.8) than among women (odds ratio 1.5, 95% CI 0.8-2.9; sex * bleeding interaction P < .01). Sex differences in the association of bleeding and mortality persisted in a landmark analysis of 120-hour survivors.

CONCLUSIONS:

In a contemporary high-risk NSTE ACS cohort, women had higher bleeding rates than did men. Paradoxically, the association between bleeding and mortality was worse among men than among women.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00089895.

PMID:
24093853
DOI:
10.1016/j.ahj.2013.07.014
[Indexed for MEDLINE]

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