Management of patients with acute coronary syndromes in real-world practice in Italy: An outcome research study focused on the use of ANTithRombotic Agents: The MANTRA registry

Gianni Casella, Giuseppe di Pasquale, Luigi Oltrona Visconti, Maria Giovanna Pallotti, Donata Lucci, Pasquale Caldarola, Marino Scherillo, Aldo p. Maggioni

Research output: Contribution to journalArticle

Abstract

Although outcomes of acute coronary syndromes (ACS) have greatly improved, bleeding is still an issue. Thus, this study aims to evaluate in-hospital management and outcomes of unselected patients with ACS focusing on antithrombotic therapies and bleeding. From 22 April 2009 to 29 December 2010, 6394 consecutive Italian patients were prospectively enrolled and followed for 6 months. Most patients (55.3%) had non-ST-elevation (NSTE) ACS. Of the ST-elevation (STE) ACS patients, 79.8% received reperfusion (mainly mechanical). In-hospital and 6-month unadjusted total mortality rates were 4.2 and 7.8% for STE-ACS and 2.5 and 6.4% for NSTE-ACS, respectively. During hospitalization, TIMI major bleeding rate was 1.2% (1.4% STE-ACS and 1.1% NSTE-ACS, respectively) and TIMI minor bleeding was 3.1%. In-hospital and 6-month unadjusted total mortality rates were 3.1 and 6.7% for patients without bleeding, 1.5 and 8.6% for minor bleeding, and 19.0 and 26.6% for TIMI major bleeding, respectively (p<0.0001). Notably, TIMI major bleeding was one of the strongest predictors of the 6-month composite end point (death or reinfarction) (STE-ACS hazard ratio, HR, 2.86, 95% confidence interval, 95% CI, 1.57−5.23; NSTE-ACS HR, 2.71, 95% CI 1.52−4.80). Predictors of in-hospital TIMI major bleeding were weight (odds ratio, OR, 0.97, 95% CI 0.95−0.99), female gender (OR 1.80, 95% CI 1.09−2.96), history of peripheral vasculopathy (OR 2.95, 95% CI 1.83−4.78), switching anticoagulant therapy (OR 2.62, 95% CI 1.36−5.05), intra-aortic balloon pump implantation (OR 4.44, 95% CI 1.85−10.69), and creatinine ≥2 mg/dl on admission (OR 3.68, 95% CI 1.84−7.33). Despite aggressive management, the rate of bleeding remains relatively low in an unselected ACS population. However, major bleeding adversely affects prognosis and physicians should tailor treatments to reduce it.

Original languageEnglish
Pages (from-to)27-34
Number of pages8
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume2
Issue number1
DOIs
Publication statusPublished - 2013

Keywords

  • Acute coronary syndromes
  • bleeding
  • outcome research

ASJC Scopus subject areas

  • Medicine(all)

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