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Eur Heart J. 2020 Feb 14;41(7):833-843. doi: 10.1093/eurheartj/ehz593.

Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry.

Author information

1
Department of Clinical Sciences, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden.
2
Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
3
Department of Medical Sciences, Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
4
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden.
5
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
6
Department of Cardiology, Heart Centre, Umea University, Umea, Sweden.
7
Department of Nursing, Umea University, Umea, Sweden.
8
Division of Cardiology, Department of Clinical Science and Education, Karolinska Institutet, Sodersjukhuset, Stockholm, Sweden.
9
Department of Cardiology, Orebro University Hospital, Orebro, Sweden.
10
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
11
Department of Medicine, Karolinska Institute, Huddinge, Stockholm, Sweden.
12
Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.

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 study period. The increase in both in-hospital and out-of-hospital 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.

KEYWORDS:

Acute myocardial infarction; Bleeding; Registry; Temporal trends

PMID:
31504404
DOI:
10.1093/eurheartj/ehz593

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