Abstract
Objective: Major bleeding is a common complication following treatment for an acute coronary syndrome (ACS) and is associated with increased mortality. We aimed to explore the temporal trend of bleeding events in relation to changes of therapeutic strategies among patients hospitalized for ACS in China.Methods: The CCC-ACS project (Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome) is a collaborative initiative of the American Heart Association and the Chinese Society of Cardiology. We analyzed 113,567 ACS patients from 241 hospitals in China from 2015 to 2019. Major bleeding was defined as intracranial bleeding, retroperitoneal bleeding, a decline in hemoglobin levels ≥3 g/dL, transfusion with overt bleeding, bleeding requiring surgical intervention, and fatal bleeding. Kruskal–Wallis test was used to examine the trend of major bleeding over time.Results: The rate of in-hospital major bleeding decreased from 6.3% in 2015 to 4.7% in 2019 (unadjusted OR = 0.74, 95% CI: 0.68–0.80, and P < 0.001). The relative changes were consistent across almost all subgroups including patients with NSTE-ACS and STEMI, although the trend was more pronounced in NSTE-ACS patients. The decrease in bleeding was accompanied by a decrease in use of GP IIb/IIIa inhibitors and parenteral anticoagulation therapy during hospitalization. The annual reduced risk of bleeding (OR = 0.91, 95% CI: 0.89–0.93) was attenuated after stepwise adjusting for baseline characteristics and antithrombotic treatments (OR = 0.95, 95% CI: 0.93–0.97), but did not change after adjusting for invasive treatment (OR = 0.95, 95% CI: 0.93–0.97).Conclusions: There was a temporal reduction in in-hospital bleeding among Chinese ACS patients during the last 5 years, which was associated with more evidence-based use of antithrombotic therapies.Clinical Trial Registration: https://www.clinicaltrials.gov, identifier: NCT02306616.
Highlights
The use of intensive antithrombotic therapies coupled with revascularization has been shown to reduce ischemic risk after an acute coronary syndrome (ACS) [1], but such strategies are performed at the expense of an increased risk of bleeding [2]
We aimed to explore the temporal trend of bleeding events in relation to changes of therapeutic strategies among patients hospitalized for ACS in China
The relative changes were consistent across almost all subgroups including patients with non-ST-segment elevation (NSTE)-ACS and segment-elevation myocardial infarction (STEMI), the trend was more pronounced in NSTE-ACS patients
Summary
The use of intensive antithrombotic therapies coupled with revascularization has been shown to reduce ischemic risk after an acute coronary syndrome (ACS) [1], but such strategies are performed at the expense of an increased risk of bleeding [2]. There are several studies describing temporal changes in bleeding rates among Western populations during the past decades [7,8,9], but no such data are available in East Asian countries. We used data from the CCC-ACS project (Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome) [10] to delineate the temporal trend of in-hospital major bleeding in relation to development of therapeutic strategies and outcomes from 2015 to 2019 among Chinese patients hospitalized for ACS
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