Impact of bleeding on mortality in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Nishihira Kensaku , Honda Satoshi , Takegami Misa , Kojima Sunao , Asaumi Yasuhide , Suzuki Makoto , Kosuge Masami , Takahashi Jun , Sakata Yasuhiko , Takayama Morimasa , Sumiyoshi Tetsuya , Ogawa Hisao , Kimura Kazuo , Yasuda Satoshi ,   the JAMIR investigators, Takenaka Takashi , Tomita Hirofumi , Yokoyama Hiroaki , Ito Tomonori , Ishida Masaru , Koeda Yorihiko , Watanabe Masafumi , Watanabe Tetsu , Toshima Taku , Shimokawa Hiroaki , Sakata Yasuhiko , Takahashi Jun , Hao Kiyotaka , Sumiyoshi Tetsuya , Takayama Morimasa , Kimura Kazuo , Kosuge Masami , Ebina Toshiaki , Suzuki Hiroshi , Maeda Atsuo , Ito Masaaki , Kurita Tairo , Masuda Jun , Tanigawa Takashi , Higaki Jitsuo , Nishimura Kazuhisa , Takahashi Naohiko , Akioka Hidefumi , Kawano Kyoko , Maemura Koji , Koide Yuji , Kojima Sunao , Tsujita Kenichi , Ogawa Hisao , Yasuda Satoshi , Asaumi Yasuhide , Nishihira Kensaku , Miyamoto Yoshihiro , Takegami Misa , Honda Satoshi , Nakajima Hiroshi , Yamaguchi Kenji , Makino Takao , Kanno Daitarou , Omoto Yasuhiro , Hotta Daisuke , Sato Toshiya , Sato Naoki , Kikuchi Arifumi , Sone Michiko , Takagi Koji , Tei Imun , Shibui Takashi , Nagamine Sho , Shimizu Wataru , Yamamoto Takeshi , Takahashi Toshiyuki , Momiyama Yukihiko , Mizuno Atsushi , Ohira Hiroshi , Yoshino Hideaki , Shigeta Youhei , Hirayama Atsushi , Okumura Yasuo , Fukamachi Daisuke , Takayama Tadateru , Niikura Hiroki , Takenaka Hiroki , Tanimoto Shuzo , Yahagi Kazuyuki , Tanaka Hiroyuki , Sato Yasuhiro , Masakazu Ohno , Miyamoto Takamichi , Hara Nobuhiro , Kishi Mikio , Shimizu Shigeo , Kurihara Ken , Ishii Yasuhiro , Kozuma Ken , Watanabe Yusuke , Takahashi Yasuhiro , Yoshimura Michihiro , Morimoto Satoshi , Hagiwara Nobuhisa , Minami Yuichiro , Yamashita Jun , Iwabuchi Kaoru , Yamauchi Takeshi , Kato Atsushi , Namiuchi Shigeto , Shinozaki Tsuyoshi , Ogata Kazunori , Tsuburaya Ryuji 
Published: March 2021

Abstract

Aims
Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with substantial mortality, although there are limited data available on bleeding in this critical condition. This study sought to investigate the incidence and impact of major in-hospital bleeding on all-cause mortality in patients with AMICS who undergo percutaneous coronary intervention (PCI).

Methods and results
Between 2015 and 2017, a total of 3411 patients hospitalized within 24 h after symptom onset were prospectively enrolled in the Japan Acute Myocardial Infarction Registry (JAMIR) and followed up for a median of 293 (interquartile range, 22–375) days. AMICS developed in 335 (9.8%) patients (mean age, 71.3 ± 13.6 years). Overall, the rate of major in-hospital bleeding (Bleeding Academic Research Consortium types 3 and 5) and in-hospital mortality was 14.6% and 28.7%, respectively. The majority of major in-hospital bleeding (73.5%) occurred within 48 h after PCI. Compared to patients without major in-hospital bleeding, those with it had higher rates of renal failure, left main coronary artery culprit lesion, and intra-aortic balloon pump or extracorporeal membrane oxygenation support, and had longer door-to-device time. The cumulative incidence of 1-year all-cause mortality was significantly higher in the major bleeding group compared to the non-major bleeding group (63.8% vs. 25.5%; log-rank P &lt; 0.001). After adjusting for confounders, major in-hospital bleeding was independently associated with increased all-cause mortality (hazard ratio, 1.70; 95% confidence interval, 1.08–2.69).

Conclusions
These findings of JAMIR indicate that major in-hospital bleeding is associated with all-cause mortality in patients with AMICS who undergo PCI.