Post-discharge bleeding in patients admitted for acute coronary syndrome (ACS) is linked to higher all-cause mortality. However, this is the case for both patients who underwent angioplasty and those who were managed with medical treatment.

These are interesting data, given that medical treatment is frequently preferred due to lower bleeding risk.

Speculation is based on the fact that, if the strategy were angioplasty, the bleeding would be more serious because patients would be receiving antiplatelet therapy and, if it had to be interrupted, the risk of thrombosis would also be high.

However, the prognosis for this unique population of patients with ACSs who receive medical treatment and subsequently bleed was almost unknown.

The objective of this paper recently published in J Am Coll Cardiol was to assess the association between post-discharge bleeding and mortality according to the index hospitalization strategy (angioplasty or medical treatment), and to contrast infarction vs. bleeding as a complication.

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A dataset of 4 large studies (APPRAISE-2, PLATO, TRACER, and TRILOGY ACS) was analyzed to establish the association between post-discharge bleeding (7 days post-ACS) and mortality.

Out of 45,011 total participants, 1,133 experienced bleeding and 2,149 died during follow-up.

The risk for mortality was significantly higher <30 days after bleeding (up to 15x higher), as well as between 30 days to 12 months (almost 3x higher) from the complication. This association between mortality and bleeding was consistent in participants treated with angioplasty or medical treatment (p for interaction = 0.240).

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The association between bleeding and mortality was similar to the association between infarction and mortality in both treatment strategies (p for interaction = 0.696).

Conclusion

Post-discharge bleeding in patients hospitalized for acute coronary syndrome is associated with increased all-cause mortality. Furthermore, the impact on the prognosis is similar for both treatment strategies (angioplasty vs. medical treatment). The impact on the prognosis of recurrent infarction is similar to that of bleeding.

Original Title: Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI.

Reference: Guillaume Marquis-Gravel et al. J Am Coll Cardiol 2020;76:162–71. https://doi.org/10.1016/j.jacc.2020.05.031.

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