Abstract 9944: Temporal Relationship Between Major Hemorrhagic Events and Mortality among Patients with Recent Acute Coronary Syndrome: Insights from ATLAS ACS 2-TIMI 51
Background: Multiple studies have demonstrated an association between hemorrhagic events and long-term mortality among patients with ACS. The goals of this analysis were to (1) describe risk factors associated with non-CABG-related TIMI major bleeding and (2) determine whether there was a temporal relationship in the association between hemorrhagic events and mortality.
Methods and results: ATLAS ACS-TIMI 51 enrolled patients with recent ACS and followed them for clinical outcomes for a median of 13 months. Multivariable Cox regression analyses adjusting for treatment and baseline characteristics were used to determine independent risk factors for non-CABG-related TIMI major bleeding. To analyze the hazard ratio and time dependency of bleeding on mortality, we used iterative day-to-day landmark analyses after the hemorrhagic event. Of the 15,526 patients enrolled, 196 (1.26%) had a non-CABG-related TIMI major bleed. Independent predictors of non-CABG-related TIMI major bleeding (p<0.10) included assignment to rivaroxaban, increasing age, male sex, diabetes mellitus, revascularization for the index event and region of enrollment. Non-CABG-related TIMI major bleeding was associated with a significantly increased risk of mortality, even after adjusting for baseline differences (HRadj 5.94, 95% CI 4.2-8.5, p<0.001). However, in the iterative landmark analysis, the hazard ratio did not differ statistically from baseline risk by 12 days after the bleeding event (Figure). Furthermore, in a landmark analysis, there was no difference in mortality among 30-day survivors of major bleeding compared with propensity-matched controls (3.9% vs. 4.1%, p=NS).
Conclusions: Among patients with recent ACS, major bleeding is associated with higher mortality, even after adjusting for differences in baseline characteristics. However, the relationship between major bleeding and mortality is no longer significant 12 days after the bleeding event.
- © 2012 by American Heart Association, Inc.