Additive effect of in-hospital TIMI bleeding and chronic kidney disease on 1-year cardiovascular events in patients with acute coronary syndrome: Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry
Journal
Heart and Vessels
Journal Volume
30
Journal Issue
4
Pages
441-450
Date Issued
2015
Author(s)
Abstract
In-hospital bleeding (IHB) is associated with the risk of subsequent cardiovascular events (CVE) in acute coronary syndrome (ACS). We investigated whether increased risk of CVE by IHB is influenced by chronic kidney disease (CKD) or both have detrimental effects on CVE. In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of <60?ml/min per 1.73?m2. The primary end point is the composite of death, non-fatal myocardial infarction and non-fatal stroke at 12?months. 53 (1.88?%) and 949 (33.7?%) patients suffered from IHB and CKD, respectively. Both IHB and CKD are independently associated with increased risk of the primary end point (HR 2.04, 95?% CI 1.05–3.99, p?=?0.037 and HR 2.17, 95?% CI 1.63–2.87, p?<?0.01, respectively). The Kaplan–Meier curves show significantly higher event rates among those with IHB and CKD in the whole, ST-elevation and non-ST elevation populations (all p?<?0.01). Patients with IHB(+)/CKD(?), IHB(?)/CKD(+) and IHB(+)/CKD(+) have 1.88-, 2.13- and 2.98-fold risk to suffer from the primary end point compared with those without IHB and CKD (p?=?0.23, <0.01 and <0.01, respectively). IHB or CKD is independently associated with poor cardiovascular outcome and patients with both IHB and CKD have the worst outcome in ACS. ? 2014, The Author(s).
SDGs
Other Subjects
acetylsalicylic acid; angiotensin 2 receptor antagonist; anticoagulant agent; beta adrenergic receptor blocking agent; clopidogrel; dipeptidyl carboxypeptidase inhibitor; fibrinogen receptor antagonist; heparin; hydroxymethylglutaryl coenzyme A reductase inhibitor; ticlopidine; warfarin; acute coronary syndrome; adult; Article; bleeding; blood clot lysis; cardiovascular disease; cardiovascular risk; cerebrovascular accident; chronic kidney disease; controlled study; death; disease association; disease registry; dyslipidemia; female; glomerulus filtration rate; heart infarction; high risk patient; hospital patient; human; in hospital bleeding; in hospital bleeding; major clinical study; male; multicenter study (topic); non ST segment elevation myocardial infarction; observational study; priority journal; prospective study; risk assessment; ST segment elevation myocardial infarction; Taiwan; thrombolysis in myocardial infarction; acute coronary syndrome; adverse effects; aged; bleeding; chronic kidney failure; clinical trial; complication; fibrinolytic therapy; hospitalization; Kaplan Meier method; middle aged; mortality; multicenter study; multivariate analysis; Myocardial Infarction; risk factor; statistical model; Acute Coronary Syndrome; Aged; Female; Glomerular Filtration Rate; Hemorrhage; Hospitalization; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardial Infarction; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors; Taiwan; Thrombolytic Therapy
Type
journal article