Impact of In-Hospital Bleeding on Postdischarge Therapies and Prognosis in Acute Coronary Syndromes
Luigi Spadafora, Matteo Betti, Fabrizio D’Ascenzo, Gaetano Maria De Ferrari, Ovidio De Filippo, Carlo Gaudio, Carlos Collet, Pierre Sabouret, Pierfrancesco Agostoni, Carlo Zivelonghi, Bianca Pernice, Gianmarco Sarto, Beatrice Simeone, Erica Rocco, Federico Russo, Salvatore Giordano, Nicola Pierucci, Alberto Testa, Stefano Cacciatore, Giuseppe Biondi‐Zoccai, Marco Bernardi
Abstract
ABSTRACT: Acute coronary syndromes (ACS) continue to pose significant challenges for clinical practitioners, particularly regarding the prediction of mid- to long-term outcomes. This study aims to investigate the impact of in-hospital bleeding (IHB) at 1-year follow-up in patients admitted for ACS. Data from 23,270 patients enrolled in the international PRAISE registry and discharged after ACS were analyzed. A total of 1060 patients experienced IHB, whereas 18,765 did not; 3445 were excluded because of missing data. The primary endpoint was all-cause mortality at 1 year. Secondary endpoints included major bleeding, reinfarction, and composite endpoints at 1 year. Patients with IHB were older, more frequently female, and had a higher prevalence of cardiovascular risk factors (all P < 0.05). At discharge, IHB patients were less likely to receive optimal medical therapy. At the 1-year follow-up, all-cause mortality, major bleeding, and reinfarction were significantly higher in the IHB group (all P s < 0.001). Bivariate analysis showed a strong association between IHB and all the outcomes of interest (all odds ratios >1; all P s < 0.001). These associations remained significant even after adjusting for several covariates, except for reinfarction (odds ratio 1.3; 95% confidence interval 0.9-2.11; P = 0.149). Age, female sex, hypertension, and peripheral artery disease were found to be independent predictors of IHB, whereas drug-eluting stent implantation, radial access, and left ventricular ejection fraction were identified as protective factors. IHB is a hallmark of frailty in patients with ACS; therefore, greater attention should be given during follow-up to patients experiencing this condition.