Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 4, pp 434–440

Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction


    • Department of MedicineMcMaster University
  • Thanu Nadarajah
    • Department of MedicineMcMaster University
  • Rizwan Afzal
    • Population Health Research InstituteHamilton Health Sciences
  • Renu Pal-Sayal
    • Population Health Research InstituteHamilton Health Sciences
  • John W. Eikelboom
    • Department of MedicineMcMaster University
    • Thrombosis Service, Hamilton Health Sciences—General Division
    • Population Health Research InstituteHamilton Health Sciences
  • Madhu K. Natarajan
    • Department of MedicineMcMaster University
    • Population Health Research InstituteHamilton Health Sciences

DOI: 10.1007/s11239-010-0462-8

Cite this article as:
Amlani, S., Nadarajah, T., Afzal, R. et al. J Thromb Thrombolysis (2010) 30: 434. doi:10.1007/s11239-010-0462-8


Major bleeding has been associated with an increased risk of ischemic events and death in patients with acute coronary syndromes. We examined the relationship between bleeding and outcome in 1,389 consecutive patients with ST-elevation myocardial infarction (STEMI) presenting to a tertiary center between May 1, 2003 and July 10, 2007. We recorded bleeding, length of stay and death during the first 30 days after hospitalization. Major bleeding occurred in 10.9% (152/1389, 95% confidence interval [CI] 9.3–12.6%). In hospital mortality was significantly higher in patients with major bleeding compared to those without major bleeding (19.7 vs. 8.2%, odds ratio [OR] 2.8, 95% CI 1.8–4.3) and was evident in the subgroups of patients with a low TIMI STEMI risk score (7.9 vs. 1.8%, OR 4.6, 95% CI 1.2–17.0) and medium risk score (11.7 vs. 6.3%, OR 2.0, 95% CI 0.6–6.2) but not those with a high TIMI STEMI risk score (28.8 vs. 26.1%, OR 1.2, 95% CI 0.7–2.0) (P for interaction = 0.024). Our data indicate that serious bleeding is common in patients with STEMI treated with thrombolysis or PCI and is a powerful predictor of death, particularly in patients with a low TIMI risk score. Therapies that maintain efficacy while reducing bleeding and that reduce the risk of death in patients who develop bleeding are needed.


Acute coronary syndromeST elevationBleedingDeathPrognosis

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© Springer Science+Business Media, LLC 2010