Coronary disease & ACSCohort study
Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry
- Registry-based cohort study
- nationwide
- SWEDEHEART registry
Authors' 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.
Study context
- Population
- Patients with acute myocardial infarction (MI) enrolled in the SWEDEHEART registry, 1995 to May 2018
- Participants
- 371,431 patients
- Outcome
- In-hospital bleeding and out-of-hospital bleeding events
- Follow-up
- 1 year
Main finding
As reported in the abstract
Time trends in bleeding
- In-hospital bleeding increased from 0.5% to a peak at 2% 2005/2006, then slightly decreased to a plateau around 1.3%
- Out-of-hospital bleeding increased stepwise from 2.5% to 3.5 % mid-period and to 4.8% at end of study period
- Bleeding increase parallel to increasing use of invasive strategy, adjunctive antithrombotic treatment, dual antiplatelet therapy (DAPT) and potent DAPT; decrease in in-hospital bleeding 2007–2010 parallel to bleeding avoidance strategies
Observational data: associations, not effects.
Further findings
Ischaemic outcomes over time
- In-hospital re-infarction decreased from 2.8% to 0.6%
- Out-of-hospital MI decreased from 12.6% to 7.1%
- Composite out-of-hospital MI, CV death and stroke decreased from 18.4% to 9.1%
Original publication
Temporal trends in bleeding events in acute myocardial infarction: insights from the SWEDEHEART registry. Eur Heart J. Published 1 September 2019. doi:10.1093/eurheartj/ehz593
Summarised from the published abstract; every number is checked against it