Incidence, Predictors and Outcome of In-Hospital Bleeding in Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction.

Bleeding after acute myocardial infarction (AMI) is associated with an increased morbidity and mortality. The frequency and consequences of bleeding events in patients with AMICS are not well described. The objective was to investigate incidence and outcome of bleeding complications among unselected patients with AMI complicated by cardiogenic shock (AMICS) and referred for immediate revascularization. Bleeding events were assessed by review of medical records in consecutive AMICS patients admitted between 2010 and 2017. Bleedings during admission were classified according to Bleeding Academic Research Consortium (BARC) classification. Patients who did not survive to admission in the intensive care unit (ICU) were excluded. Of the 1716 patients admitted with AMICS, 1532 patients (89%) survived to ICU admission. At 30 days, mortality was 48%. Severe bleedings classified as BARC 3/5 were seen in 87 non-CABG patients (6.1%). Comorbidity did not differ among patients, however patients who had a BARC 3/5 bleeding had significantly higher lactate and lower systolic blood pressure at admission, indicating a more severe state of shock. The use of mechanical assist devices was significantly associated with severe bleeding events. Univariable analysis showed that patients with a BARC 3/5 bleeding had a significantly higher 30-day mortality hazard compared to patients without severe bleedings. The association did not sustain after multivariable adjustment (HR 0.90, 95% CI 0.64;1.26, p=0.52). In conclusion, severe bleeding events according to BARC classification in an all-comer population of patients with AMICS, were not associated with higher mortality when adjusting for immediate management, hemodynamic and metabolic state. This indicates that mortality in these patients is primarily related to other factors.

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