Incidence and consequence of major bleeding in primary percutaneous intervention for ST-elevation myocardial infarction in the era of radial access: an analysis of the international randomized Acute myocardial infarction Treated with primary angioplasty and intravenous enoxaparin Or unfractionated heparin to Lower ischemic and bleeding events at sh

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• 作者：Cyril Pellaton ; MD^a ; ^b ; Guillaume Cayla ; MD ; PhD^c ; Johanne Silvain ; MD ; PhD^a ; Uwe Zeymer ; MD ; PhD^e ; Marc Cohen ; MD^f ; Patrick Goldstein ; MD^g ; Kurt Huber ; MD ; PhD^h ; Charles Pollack Jr. ; MDⁱ ; Mathieu Kerneis ; MD^a ; Jean-Philippe Collet ; MD ; PhD^a ; Eric Vicaut ; MD ; PhD^j ; Gilles Montalescot ; MD ; PhD^a ; ^d ; ^{gilles.montalescot@psl.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; for the ATOLL Investigators
• 刊名：American Heart Journal
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：170
• 期：4
• 页码：778-786
• 全文大小：527 K

文摘

The aims of the study are to compare the outcome with and without major bleeding and to identify the independent correlates of major bleeding complications and mortality in patients described in the ATOLL study.

Methods

The ATOLL study included 910 patients randomly assigned to either 0.5 mg/kg intravenous enoxaparin or unfractionated heparin before primary percutaneous coronary intervention. Incidence of major bleeding and ischemic end points was assessed at 1 month, and mortality, at 1 and 6 months. Patients with and without major bleeding complication were compared. A multivariate model of bleeding complications at 1 month and mortality at 6 months was realized. Intention-to-treat and per-protocol analyses were performed.

Results

The most frequent bleeding site appears to be the gastrointestinal tract. Age >75 years, cardiac arrest, and the use of insulin or >1 heparin emerged as independent correlates of major bleeding at 1 month. Patients presenting with major bleeding had significantly higher rates of adverse ischemic complications. Mortality at 6 months was higher in bleeders. Major bleeding was found to be one of the independent correlates of 6-month mortality. The addition or mixing of several anticoagulant drugs was an independent factor of major bleeding despite the predominant use of radial access.

Conclusions

This study shows that major bleeding is independently associated with poor outcome, increasing ischemic events, and mortality in primary percutaneous coronary intervention performed mostly with radial access.