Associations of major bleeding and recurrent myocardial infarction with the incidence and timing of mortality in patients with ST-segment elevation myocardial infarction

Purpose: The purpose of the current analysis was to investigate the temporal mortality pattern after recurrent MI (reMI) and severe bleeding in STEMI patients. Methods: From 1-1-2003 to 31-7-2008, 2002 patients were treated with primary PCI for STEMI and followed for the occurrence of recurrent MI and GUSTO severe bleeding. Hazard ratios for 4 year mortality for discrete time intervals after bleeding or reMI were calculated in a time-dependent, covariate adjusted Cox model. Results: After a reMI, the risk of subsequent mortality was high in the first days after the reMI, gradually decreased over time, but remained elevated long after the reMI (see table). After a bleeding, the risk of mortality was high in the first days after the bleeding, but rapidly decreased to non-significant. Table 1. Impact of recurrent MI and GUSTO severe bleeding on subsequent mortality to 4 years Conclusions: The occurrence of reMI and bleeding in the first year after STEMI are both associated with subsequent mortality. The risk implication of reMI however was greater and more sustained than that of severe bleeding.