Association of spontaneous and procedure-related bleeds with short- and long-term mortality after acute coronary syndromes: An analysis from the PLATO trial

Gregory Ducrocq, Phillip Schulte, Richard C. Becker, Christopher P. Cannon, Robert A. Harrington, Claes Held, Anders Himmelmann, Riitta Lassila, Robert F. Storey, Emmanuel Sorbets, Lars Wallentin, Philippe Gabriel Steg

Research output: Contribution to journalArticle

35 Scopus citations

Abstract

Aims: We sought to describe the differential effect of bleeding events in acute coronary syndromes (ACS) on short- and long-term mortality according to their type and severity. Methods and results: The PLATO trial randomised 18,624 ACS patients to clopidogrel or ticagrelor. Post-randomisation bleeding events were captured according to bleeding type (spontaneous or procedure-related), with PLATO, TIMI, and GUSTO definitions. The association of bleeding events with subsequent short-term (<30 days) and long-term (>30 days) all-cause mortality was assessed using time-dependent Cox proportional hazard models. A model was fitted to compare major and minor bleeding for mortality prediction. Of 18,624 patients, 2,189 (11.8%) had at least one PLATO major bleed (mean follow-up 272.2±123.5 days). Major bleeding was associated with higher short-term mortality (adjusted hazard ratio [HR] 9.28; 95% confidence interval [CI]: 7.50-11.48) but not with long-term mortality (adjusted HR 1.28; 95% CI: 0.93-1.75). Spontaneous bleeding was associated with short-term (adjusted HR 14.59; 95% CI: 11.14-19.11) and long-term (adjusted HR 3.38; 95% CI: 2.26-5.05) mortality. Procedure-related bleeding was associated with short-term mortality (adjusted HR 5.29; 95% CI: 4.06-6.87): CABG-related and non-coronary-procedure-related bleeding were associated with a higher short-term mortality, whereas PCI or angiography-related bleeding was not associated with either short- or long-term mortality. Similar results were obtained using the GUSTO and TIMI bleeding definitions. Conclusions: Major bleeding is associated with high subsequent mortality in ACS. However, this association is much stronger in the first 30 days and is strongest for spontaneous (vs. procedure-related) bleeding.

Original languageEnglish (US)
Pages (from-to)737-745
Number of pages9
JournalEuroIntervention
Volume11
Issue number7
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

    Fingerprint

Keywords

  • Acute coronary syndromes
  • Haemorrhage
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Ducrocq, G., Schulte, P., Becker, R. C., Cannon, C. P., Harrington, R. A., Held, C., Himmelmann, A., Lassila, R., Storey, R. F., Sorbets, E., Wallentin, L., & Steg, P. G. (2015). Association of spontaneous and procedure-related bleeds with short- and long-term mortality after acute coronary syndromes: An analysis from the PLATO trial. EuroIntervention, 11(7), 737-745. https://doi.org/10.4244/EIJY14M09-11