Abstract
This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS.
Highlights
This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS)
Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor has long been recommended as the cornerstone of pharmacologic treatment in patients with acute myocardial infarction (AMI) and chronic coronary syndrome (CCS) after they have received coronary s tenting[1,2,3]
Studies have validated the accuracy of the National Health Insurance Research Database (NHIRD) with regard to the diagnoses of MI and stroke as well as mortality associated with these e vents[16,17,18]
Summary
This nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS. Advances in antiplatelet therapy have improved clinical outcomes of patients with coronary artery disease through the reduction of ischemic and thrombotic events, with the tradeoff of increased risk of bleeding. We used the National Health Insurance Research Database (NHIRD) of Taiwan to estimate the incidence rates of clinical events (bleeding, MI, stroke, and all-cause mortality) in patients with AMI and CCS who had received DAPT after coronary stenting.
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