Sedhom Ramy, Mohammad Adeba, Khedr Mohamed, Megaly Michael, Waldman Carly, Bharadwaj Aditya S, Kobo Ofer, Sayed Ahmed, Abramov Dmitry
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA. Electronic address: https://twitter.com/RamySedhomMD.
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Cardiovasc Revasc Med. 2025 Mar;72:10-15. doi: 10.1016/j.carrev.2024.09.011. Epub 2024 Sep 21.
To examine the characteristics and outcomes of acute myocardial infarction (AMI) in patients with bleeding and/or hypercoagulable disorders.
Studies examining the outcomes of AMI in bleeding/hypercoagulable disorders are scarce.
The Nationwide Readmissions Database was utilized to identify hospitalizations with AMI from 2016 to 2020. The study cohort was divided into 4 groups: (1) MI without bleeding or hypercoagulable disorders, (2) MI with bleeding disorders, (3) MI with hypercoagulable disorders and (4) MI with mixed disorders. The main outcome was all-cause in-hospital mortality.
A total of 4,206,005 weighted hospitalizations with AMI were identified during the study period, of which 382,118 (9.1 %) had underlying bleeding or hypercoagulable disorders. The utilization of invasive strategies for the management of MI was highest in patients without bleeding or hypercoagulable disorders (62.6 %) and lowest in patients with mixed disorders (39.3 %). In-hospital mortality was higher among patients with bleeding (adjusted odds ratio [OR] 1.22; 95 % confidence interval [CI] 1.21, 1.24) and mixed disorders (aOR 3.38; 95 % CI 3.27, 3.49) compared with patients without bleeding or hypercoagulable disorders. Among patients with any bleeding or hypercoagulable disorder, those who underwent invasive strategy had lower adjusted odds of in-hospital mortality (aOR 0.28; 95 % CI 0.27, 0.30), ischemic stroke (aOR 0.60; 95 % CI 0.56, 0.64), bleeding (aOR 0.63; 95 % CI 0.61, 0.65), blood transfusion (aOR 0.95; 95 % CI 0.91, 0.99) and 30-day urgent readmissions (aOR 0.70; 95 % CI 0.68, 0.72).
The inpatient management and outcomes of AMI in patients with bleeding/hypercoagulable disorders differ from patients without those disorders. Revascularization in the setting of AMI was associated with lower in-hospital mortality, which suggests that patients with bleeding/hypercoagulable disorders can be evaluated for standard approaches to managing AMI; however, confounding by indication may be a concern.
研究合并出血和/或高凝性疾病患者急性心肌梗死（AMI）的特征及预后。
关于出血/高凝性疾病患者AMI预后的研究较少。
利用全国再入院数据库确定2016年至2020年期间因AMI住院的患者。研究队列分为4组：（1）无出血或高凝性疾病的心肌梗死（MI）；（2）有出血性疾病的MI；（3）有高凝性疾病的MI；（4）有混合性疾病的MI。主要结局为全因院内死亡率。
在研究期间共确定了4,206,005例加权AMI住院患者，其中382,118例（9.1%）有潜在的出血或高凝性疾病。在无出血或高凝性疾病的患者中，用于管理MI的侵入性策略使用率最高（62.6%），而在有混合性疾病的患者中最低（39.3%）。与无出血或高凝性疾病的患者相比，有出血（调整优势比[OR]1.22；95%置信区间[CI]1.21, 1.24）和混合性疾病（aOR 3.38；95%CI 3.27, 3.49）的患者院内死亡率更高。在任何有出血或高凝性疾病的患者中，接受侵入性策略的患者院内死亡（aOR 0.28；95%CI 0.27, 0.30）、缺血性卒中（aOR 0.60；95%CI 0.56, 0.64）、出血（aOR 0.63；95%CI 0.61, 0.65）、输血（aOR 0.95；95%CI 0.91, 0.99）和30天紧急再入院（aOR 0.70；95%CI 0.68, 0.72）的调整后优势较低。
合并出血/高凝性疾病的AMI患者的住院管理和预后与无这些疾病的患者不同。AMI时的血运重建与较低的院内死亡率相关，这表明合并出血/高凝性疾病的患者可接受AMI管理的标准方法评估；然而，可能存在指征性混杂因素。
