Implications of bleeding on subsequent cardiovascular events in patients with atrial fibrillation after acute coronary syndrome or PCI

• Published in: Thrombosis research 2023-09, Vol.229, p.243-251
• Main Authors: Mo, Ran, Wang, Hao-Yu, Yang, Yan-min, Zhang, Han, Suo, Ni, Wang, Jing-yang
• Format: Article
• Language: English
• Subjects: Acute coronary syndrome; Atrial fibrillation; Cardiovascular events; Hemorrhage
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/j.thromres.2023.08.002

The association between bleeding and subsequent major adverse cardiac and cerebrovascular events (MACCE) remains poorly characterized. We aimed to evaluate the impact of hemorrhagic events in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI). A total of 1877 consecutive patients with AF and ACS or undergoing PCI were prospectively recruited. The primary endpoint was MACCE, including all-cause death, myocardial infarction, ischemic stroke, systemic embolism or ischemia-driven revascularization during follow-up. Post-discharge bleeding was graded according to TIMI criteria. Associations between bleeding and subsequent MACCE were examined using time-dependent multivariate Cox regression after adjusting for baseline covariates and the time from bleeding. During a median follow-up of 34.2 months, 341 (18.2 %) had TIMI major or minor bleeding events, of whom 86 (25.2 %) also experienced MACCE. The risk of MACCE was significantly higher in patients with bleeding than those without (8.85 % versus 6.99 % per patient-year; HR, 1.568, 95 % CI, 1.232–1.994). In patients who had both bleeding and MACCE, 65.1 % (56 of 86) bleeding events occurred first. Temporal gradients in MACCE risk after major bleeding was highest within 30 days (HRadj, 23.877; 95 % CI, 12.810–44.506) and remained significant beyond 1 year (HRadj, 3.640; 95 % CI, 1.278–10.366). Minor bleeding was associated with increased risk of MACCE within 1 year. In patients with AF and ACS or PCI, major and minor bleeding were associated with subsequent MACCE with time-dependency. Our findings may aid in better defining net clinical benefit of optimal antithrombotic therapy. •Patients experiencing post-discharge bleeding were more likely to develop major adverse cardiac and cerebrovascular events.•The temporal gradients in MACCE risk after bleeding were highest in the first 30 days and then decreased.•The impact of TIMI major bleeding persisted beyond one year, while minor bleeding did not.