One-year and 5-year transition risks between major bleeding, reinfarction, and death following acute myocardial infarction in England and Wales: a population-based cohort study
Authors' conclusion
In this national AMI cohort, 5-year direct death and bleeding events were more frequent than reinfarction, and the highest mortality occurred in women after AMI admission and in men following reinfarction. These transition patterns quantify the substantial absolute risks patients face post-AMI and highlight important sex-specific differences in adverse outcomes.
Study context
- Population
- Acute myocardial infarction (AMI) patients across England and Wales between 2005 and 2021patients included
- Participants
- 837,384 patients
- Exposure
- Females vs males
- Outcome
- First event post-AMI admission
Methodological detailsnational registry data, multistate modelling (six-state model with nine transitions)
- National registry data
- Multistate modelling (six-state model with nine transitions)
Main finding
As reported in the abstract
Bleeding
19.8%
Reinfarction
8.1%
Death
20.6%
Observational data: associations, not effects.
Further findings
| Outcome | Females | Males |
|---|---|---|
| Adjusted transition IRs (×100 person-years) · 1-year | ||
| AMI admission → bleeding | 6.7 (95% CI 6.5-6.9) | 5.2 (95% CI 5.0-5.4) |
| AMI admission → reinfarction | 0.2 (95% CI 0.2-0.2) | 0.2 (95% CI 0.2-0.2) |
| AMI admission → death | 43.5 (95% CI 41.9-45.2) | 23.7 (95% CI 22.8-24.6) |
| Bleeding → death | 22.2 (95% CI 20.9-23.5) | 14.5 (95% CI 13.6-15.4) |
| Reinfarction → death | 41.9 (95% CI 38.1-46.0) | 25.9 (95% CI 23.8-28.3) |
| Adjusted transition IRs (×100 person-years) · 5-year | ||
| AMI admission → bleeding | 2.1 (95% CI 2.0-2.2) | 1.6 (95% CI 1.6-1.7) |
| AMI admission → reinfarction | 0.04 (95% CI 0.04-0.05) | 0.04 (95% CI 0.04-0.04) |
| AMI admission → death | 17.5 (95% CI 16.9-18.2) | 9.5 (95% CI 9.2-9.9) |
| Bleeding → death | 9.7 (95% CI 9.2-10.3) | 6.3 (95% CI 5.9-6.8) |
| Reinfarction → death | 17.6 (95% CI 16.0-19.4) | 10.9 (95% CI 10.0-11.9) |
Death after first event
- Of those with bleeding, died
- 39.4%
- Of those with reinfarction, died
- 49.9%
Transition rates by sex
- Females had higher rates of transitioning to any of the five states than males
Transition rates by diabetes and ethnicity
- Those with diabetes and white patients had higher transition rates than those without diabetes and black patients
Original publication
One-year and 5-year transition risks between major bleeding, reinfarction, and death following acute myocardial infarction in England and Wales: a population-based cohort study. Eur Heart J Acute Cardiovasc Care. Published 24 June 2026. doi:10.
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