Author + information
- Received December 2, 2019
- Revision received February 4, 2020
- Accepted February 27, 2020
- Published online May 18, 2020.
- Anne Freund, MDa,b,c,∗ (, )
- Alexander Jobs, MDa,b,d,
- Philipp Lurz, MD, PhDa,
- Hans-Josef Feistritzer, MD, PhDa,
- Suzanne de Waha-Thiele, MDb,d,
- Roza Meyer-Saraei, PhDb,d,
- Gilles Montalescot, MDe,
- Kurt Huber, MDf,
- Marko Noc, MDg,
- Stephan Windecker, MDh,
- Uwe Zeymer, MDi,j,
- Taoufik Ouarrak, PhDi,
- Steffen Schneider, PhDi,
- Holger Thiele, MDa,c,∗ and
- Steffen Desch, MDa,b,d,∗
- aHeart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
- bGerman Center for Cardiovascular Research, partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- cLeipzig Heart Institute, Leipzig, Germany
- dDepartment of Cardiology, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- eACTION Study Group, Centre Hospitalier Universitaire Pitié-Salpêtrière, Sorbonne Université, Paris, France
- fDepartment of Cardiology, Wilhelminenspital, Sigmund Freud University Medical School, Vienna, Austria
- gCenter of Intensive Internal Medicine, University Medical Center Ljubljana, Ljubljana, Slovenia
- hDepartment of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- iStiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
- jMedizinische Klinik B, Klinikum Ludwigshafen, Ludwigshafen, Germany
- ↵∗Address for correspondence:
Dr. Anne Freund, Heart Center Leipzig at the University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstraße 39, D-04289 Leipzig, Germany.
Objectives This study sought to determine frequency, associated factors, and impact of bleeding in infarct-related cardiogenic shock.
Background Early revascularization is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock. On the downside, invasive treatment and accompanying antithrombotic therapies are associated with an increased bleeding risk. Prospective data assessing the incidence, severity, risk factors, and prognostic implication of bleeding in patients with cardiogenic shock are scarce.
Methods As a pre-defined subanalysis of the CULPRIT-SHOCK (PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock) randomized trial, we examined distribution of bleeding events in 684 patients with infarct-related cardiogenic shock and compared patients with any bleeding to those without.
Results A total of 21.5% patients experienced at least 1 bleeding event until 30 days after randomization. The vast majority of bleeding (57%) occurred within the first 2 days of hospitalization. Patients with bleeding had prolonged catecholamine treatment and mechanical ventilation and there was a significant association with sepsis, peripheral ischemic complications, new atrial fibrillation, and ventricular fibrillation. In multivariable analysis, bleeding was associated with a significantly higher mortality (hazard ratio: 2.11; 95% confidence interval: 1.63 to 2.75; p < 0.0001). Treatment with active mechanical support by extracorporeal membrane oxygenation or Impella emerged as the major risk factor for bleeding.
Conclusions Risk of bleeding in infarct-related cardiogenic shock is high and associated with increased mortality.
↵∗ Drs. Thiele and Desch contributed equally to this work.
∗Drs. Thiele and Desch contributed equally to this work. This work was supported by the European Union and the German Centre for Cardiovascular Research. Dr. Montalescot has received institutional research grants or consulting/lecture fees from Abbott, Amgen, Actelion, the American College of Cardiology Foundation, AstraZeneca, Axis-Santé, Bayer, Boston Scientific, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, China Heart House, Daiichi-Sankyo, Idorsia, Elsevier, Europa, Fédération Française de Cardiologie, ICAN, Lead-Up, Medtronic, Menarini, MSD, Novo Nordisk, Partners, Pfizer, Quantum Genomics, Sanofi, Servier, and WebMD. Dr. Windecker has received research, educational, and training grant support from Amgen, Abbott, Bayer, Bristol-Myers Squibb, Boston Scientific, Biotronik, Medtronic, Edwards Lifesciences, Sinomed, and Polares. Dr. Zeymer has received grants and personal fees from Bristol-Myers Squibb, Novartis, and AstraZeneca; personal fees from Boehringer Ingelheim, MSD, Sanofi, Trommsdorf, and Amgen; and grants and personal fees from Pfizer and Bayer, outside the submitted work. Dr. Ouarrak has received institutional research grants from the German Centre for Cardiovascular Research. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Interventions author instructions page.
- Received December 2, 2019.
- Revision received February 4, 2020.
- Accepted February 27, 2020.
- 2020 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.