Abstract 2025: TIMI Major Bleeding Independently Predicts Mortality in an Unselected STEMI Population: Results from the AMI-Quebec Study
Major bleeding was recently identified as an independent predictor of adverse clinical outcomes in patients with acute coronary syndromes. We sought to determine the impact of major bleeding on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) and the clinical characteristics associated with major bleeding. AMI-QUEBEC was a retrospective cohort study of consecutive STEMI patients admitted to 17 selected acute-care hospitals in the Province of Quebec (Canada) in 2003. Research coordinators identified major bleeding complications according to the Thrombolysis In Myocardial Infarction (TIMI) classification. The cohort included 1,655 patients. Thirty-eight percent (38%) of patients were treated with fibrinolysis, 51% with primary percutaneous coronary intervention (PCI) (65% femoral approach) and 12% received no reperfusion therapy. Twenty-eight percent (28%) of patients were females, mean age was 62.3 years, mean weight was 77.5 kg, 5.1% had prior stroke, and baseline serum creatinine was 104 μmol/L. Concomitant medications included clopidogrel loading in 32%, glycoprotein IIb/IIIa inhibitor 24%, unfractionated heparin 82% and low molecular weight heparin 9%. TIMI major bleeding occurred in 7.3% of patients. Overall in-hospital mortality was 11.6%. Independent predictors of mortality were
major bleeding (OR 4.36 [2.48 –7.68]) and
age (OR 1.06 [1.03–1.08] per year increase).
Independent predictors of TIMI major bleeding were
femoral approach (OR 11.2 [3.9 –32.1])
female gender (OR 2.8 [1.5–5.1]) and
peak creatinine (OR1.02 [1.01–1.03] per 1μmol/L increase).
Age, weight, blood pressure, mode of reperfusion, clopidogrel, aspirin, anticoagulant, clopidogrel load, glycoprotein IIb/IIIa inhibitors, PCI within 24 hours post-fibrinolysis were not independent predictors of major bleeding. TIMI major bleeding conferred a greater than four-fold increase in risk of short-term mortality in an unselected STEMI population. The use of the femoral approach for vascular access was the most powerful predictor of major bleeding in this patient population, highlighting the impact of vascular access site selection.