In-hospital outcomes associated with fibrinolytic and thienopyridine use in patients with ST-segment elevation acute myocardial infarction. The global registry of acute coronary events
Center for Outcomes Research; Department of Medicine, Division of Cardiovascular Medicine
Medical Subject Headings
Acute Disease; Aged; Aged, 80 and over; Coronary Disease; Electrocardiography; Endpoint Determination; Female; Fibrinolytic Agents; Hemorrhage; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Prospective Studies; Pyridines; Registries
Health Services Research
INTRODUCTION AND OBJECTIVES: To investigate how thienopyridine treatment, with or without associated fibrinolysis, affects the rates of major bleeding and inhospital death in patients with ST-elevation myocardial infarction (STEMI).
METHODS: The rates of major bleeding and in-hospital death were studied in 14,259 consecutive patients with STEMI. During hospitalization, 5340 (38%) received thienopyridines, 3007 (21%) received fibrinolytic drugs, and 2044 (14%) received both.
RESULTS: Major bleeding occurred more frequently in patients who received thienopyridines with or without fibrinolytics, in 4.6% and 4.1%, respectively, compared with 2.3% in those who received fibrinolytics alone and 2.8% in those who received neither (P< .001). Multivariate analysis, which included adjustments for risk factors for bleeding, percutaneous coronary intervention and cardiac catheterization, showed that thienopyridine treatment was an independent risk factor for bleeding (odds ratio=1.68; 95% confidence interval, 1.23-2.31). In-hospital mortality was lower in patients who received a thienopyridine, and such treatment was an independent predictor of lower mortality (odds ratio=0.50; 95% confidence interval, 0.39-0.60).
CONCLUSIONS: Thienopyridine treatment was associated with an increased risk of major bleeding but also with a better in-hospital prognosis. These findings in unselected patients with STEMI, who are representative of those seen in daily clinical practice, complement, but do not replace, the data obtained in randomized clinical trails of selected patients.
Rights and Permissions
Citation: Rev Esp Cardiol. 2009 May;62(5):501-9.