Trends in Bleeding Events Among Patients With Acute Coronary Syndrome in China, 2015 to 2019: Insights From the CCC-ACS Project

Abstract

Objective: Major bleeding is a common complication following treatment for an acute coronary syndrome (ACS) and is associated with increased mortality. We aimed to explore the temporal trend of bleeding events in relation to changes of therapeutic strategies among patients hospitalized for ACS in China.Methods: The CCC-ACS project (Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome) is a collaborative initiative of the American Heart Association and the Chinese Society of Cardiology. We analyzed 113,567 ACS patients from 241 hospitals in China from 2015 to 2019. Major bleeding was defined as intracranial bleeding, retroperitoneal bleeding, a decline in hemoglobin levels ≥3 g/dL, transfusion with overt bleeding, bleeding requiring surgical intervention, and fatal bleeding. Kruskal–Wallis test was used to examine the trend of major bleeding over time.Results: The rate of in-hospital major bleeding decreased from 6.3% in 2015 to 4.7% in 2019 (unadjusted OR = 0.74, 95% CI: 0.68–0.80, and P < 0.001). The relative changes were consistent across almost all subgroups including patients with NSTE-ACS and STEMI, although the trend was more pronounced in NSTE-ACS patients. The decrease in bleeding was accompanied by a decrease in use of GP IIb/IIIa inhibitors and parenteral anticoagulation therapy during hospitalization. The annual reduced risk of bleeding (OR = 0.91, 95% CI: 0.89–0.93) was attenuated after stepwise adjusting for baseline characteristics and antithrombotic treatments (OR = 0.95, 95% CI: 0.93–0.97), but did not change after adjusting for invasive treatment (OR = 0.95, 95% CI: 0.93–0.97).Conclusions: There was a temporal reduction in in-hospital bleeding among Chinese ACS patients during the last 5 years, which was associated with more evidence-based use of antithrombotic therapies.Clinical Trial Registration:https://www.clinicaltrials.gov, identifier: NCT02306616.

Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Myocardial Infarction: A Multicenter, Randomized, Double-Blind Trial

“…3 The RIGHT trial was thus designed to evaluate the efficacy and safety of PPA versus interruption of anticoagulation after primary PCI for STEMI. Based on the previous literature, 15,[19][20][21][30][31][32] we selected low doses of anticoagulants for the prevention of thrombotic events after primary PCI, and these regimens proved to be safe for ≥48 hours after primary PCI, which often corresponds to the period of intensive cardiac care for uncomplicated MI. The use of low-dose anticoagulants combined with a default strategy of radial access was safe despite the general use of dual antiplatelet therapy and administration of a glycoprotein IIb/IIIa inhibitor in 18.4% of patients.…”

“…In the CCC-ACS project, the in-hospital major adverse cardiovascular event rate declined from 2.9% in 2015 to 1.4% in 2019. 32 Second, the study population was different across studies. In the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) and BRIGHT-4 studies (Bivalirudin With Prolonged Full Dose Infusion Versus Heparin Alone During Emergency PCI), patients with cardiogenic shock or cardiac arrest, who have a higher risk of events, were not excluded.…”

Efficacy and safety of bivalirudin bridging enoxaparin versus fondaparinux in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention: evidence from a single-center study

“…Currently, PPCI is the most effective treatment to reduce the mortality rate of AMI. Perioperative bleeding complications of PCI reduce patient satisfaction, delay discharge, and increase costs; furthermore, they increase the risk of death, myocardial infarction, and stroke within one year [8][9][10]. Hence, there is an urgent need to explore the perioperative anticoagulation strategy of PPCI.…”