Study: In-hospital bleeds linked to long-term mortality risk

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In-hospital bleeding was found to be associated with short-, intermediate- and long-term mortality risk in older patients hospitalized for non-STEMI, according to a study published online March 5 in the European Heart Journal.

“Bleeding complications have been associated with short-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI),” wrote Renato D. Lopes, MD, of the Duke Clinical Research Institute and Duke University Medical Center in Durham, N.C., and colleagues. However, the researchers said that the link between long-term outcomes and mortality still remains unclear.

To look at mortality rates that were associated with in-hospital bleeding for non-STEMI patients, Lopes et al evaluated 32,895 non-STEMI patients age 65 and older. The study cohort was identified from CRUSADE registry data.

In-hospital bleeding rates associated with 30-day (short-term), one-year (intermediate) and three-year (long-term) mortality were assessed. These rates were also evaluated in patients who did and did not receive PCI.

During the study, the researchers calculated hazard ratios for mortality for bleeders vs. non-bleeders for the following time intervals: hospital discharge to 30 days; 31 days to one year; one year to three years; and three years and beyond.

It was reported that 11.9 percent of patients experienced an in-hospital bleeding event. Additionally, cumulative mortality was higher in patients who experienced a major bleed compared to those who did not at 30 days, one year and three years. Even after rates were adjusted, mortality was still found to be higher over time at all time points: discharge to 30 days; 31 days to one year; one year to three years; and after three years.

Lastly, the researchers found in-hospital bleeding in patients who underwent PCI to be associated with a higher adjusted mortality rate even after three years.

“In-hospital major bleeding is associated with short-, intermediate-, and long-term mortality among older patients hospitalized for NSTEMI—this association is strongest within the first 30 days, but remains significant long term, particularly among PCI-treated patients,” the authors wrote.

The authors summed the longer duration of risk in patients who bled cast doubt on its relationship with long-term mortality. “Rather, major bleeding likely identified patients with an underlying risk for mortality,” they wrote.