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Long term clinical outcome and bleeding complications among hospital survivors with acute coronary syndromes
  1. P Wong,
  2. A Robinson,
  3. S Shaw,
  4. E Rodrigues
  1. Aintree Cardiac Centre, University Hospital Aintree, Liverpool, UK
  1. Correspondence to:
 Dr P Wong
 Aintree Cardiac Centre, University Hospital Aintree, Liverpool L9 7AL, UK; peter.wong{at}aht.nwest.nhs.uk

Abstract

Objective: To examine the 21 month clinical outcome and bleeding complications in hospital survivors with non-ST segment elevation acute coronary syndromes (NSTEACS) who were discharged with combined clopidogrel and aspirin anti-thrombotic therapy, and compare with those having ST segment elevation myocardial infarction (STEMI) who were discharged with aspirin alone.

Design: Observational study.

Setting: A large university hospital.

Patients: 224 patients were admitted to hospital with either NSTEACS or STEMI, and survived to discharge between 1 October 2001 and 31 December 2002.

Main outcome measures: Cardiovascular death, total death, new myocardial infarction, unstable angina requiring hospitalisation, stroke or transient ischaemic attack, coronary revascularisation; and fatal, life threatening, major and minor bleeding over 21 months after discharge.

Results: Despite having no or small infarct (median maximum creatine kinase 155 v 1295 u/l; p<0.001) and taking more antianginal drugs, patients with NSTEACS had similar rates of cardiovascular death (9.5% v 8.3%; p = NS), new myocardial infarction (9.5% v 6.5%; p = NS) or unstable angina requiring hospitalisation (15.5% v 10.2%; p = NS) when compared with STEMI. Fatal, life threatening or major bleeding were <1% in both groups (p = NS); and minor bleeding occurred in 4.3% NSTEACS and 2.8% STEMI patients respectively (p = NS).

Conclusions: Patients with NSTEACS had a similar and unfavourable long term outcome when compared with STEMI. There was no difference in serious bleeding complications between both groups.

  • NSTEACS, non-ST segment elevation acute coronary syndromes
  • STEMI, ST segment elevation myocardial infarction
  • non-ST segment elevation acute coronary syndromes (NSTEACS)
  • ST segment elevation myocardial infarction (STEMI)
  • cardiovascular death
  • bleeding
  • clopidogrel

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Footnotes

  • Funding: none.

  • Conflicts of interest: PW has received an unconditional research grant for the study from Bristol-Myers Squibb Pharmaceuticals Limited.

  • This study has been approved by the Sefton Local Research Ethics Committee.

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