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

Frontiers in Cardiovascular Medicine

Yaling Han¹  Guanqi Zhao²  Yan Yan²  Wei Gong²  Xiao Wang²  Shaoping Nie²  Changsheng Ma³  Yong Huo⁴  Yongchen Hao⁵  Mengge Zhou⁵  Jun Liu⁵  Jing Liu⁵  Dong Zhao⁵  Sidney C. Smith⁶  Gregg C. Fonarow⁷  Louise Morgan⁸  Junbo Ge⁹ 

[1] Cardiovascular Research Institute and Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China;Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;Department of Cardiology, Peking University First Hospital, Beijing, China;Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China;Division of Cardiology, University of North Carolina, Chapel Hill, NC, United States;Divisions of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States;International Quality Improvement Department, American Heart Association, New York, NY, United States;Zhongshan Hospital, Fudan University, Shanghai, China;

关键词: acute coronary syndrome;    bleeding;    temporal trend;    antithrombotic therapy;    outcome;   

DOI  :  10.3389/fcvm.2021.769165

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown