AMI patients with multivessel disease had higher 1-year MACE (8.8% vs 3.5%) and bleeding risk (HR 1.42) compared to single-vessel disease patients.
Does multivessel disease increase the risk of MACE and major bleeding events compared to single-vessel disease in patients with acute myocardial infarction?
In patients with acute myocardial infarction, the presence of multivessel disease is independently associated with both a higher risk of ischemic events and major bleeding, highlighting the need for carefully tailored antithrombotic strategies.
Absolute Event Rate: 0% vs 0%
Abstract Background Patients with acute myocardial infarction (AMI) and multivessel disease require intensive antithrombotic therapy due to their elevated ischemic risk. However, these patients often exhibit characteristics associated with a higher bleeding risk. While achieving optimal revascularization is an important goal in multivessel disease, the bleeding risk associated with this patient population remains insufficiently characterized. Purpose This post-hoc analysis aimed to evaluate the bleeding risk in AMI patients with multivessel disease. Methods Using data from the Japan AMI Registry (JAMIR), a nationwide, multicenter, prospective study, we conducted a post-hoc analysis of 3,242 AMI patients (M/F 2,499/743, mean age 68 years). Patients were categorized based on the presence of single-vessel or multivessel disease. The incidence of major adverse cardiovascular events (MACE) (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke) and Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding events was compared over a 1-year follow-up. Results Among the 3,242 patients, 1,822 had single-vessel disease, and 1,420 had multivessel disease (849 with two-vessel and 571 with three-vessel disease). Patients who experienced bleeding events had a significantly higher risk of all-cause mortality (hazard ratio HR 6.95, 95% confidence interval CI 5.14–9.40, P0.001). Compared to those with single-vessel disease, patients with multivessel disease had a significantly higher incidence of MACE (1-year event rate: 3.5% vs. 8.8%, P0.001) and bleeding events (BARC type 3 or 5) (Figure 1). After adjusting for clinically relevant factors, multivessel disease remained independently associated with an increased bleeding risk (HR 1.42, 95% CI 1.01–2.00, P=0.045). Additionally, post-discharge bleeding events were significantly more frequent in patients with multivessel disease, and this association remained significant after adjusting for the Japan high bleeding risk score (HR 1.79, 95% CI 1.01–3.16, P=0.046) (Figure 2). Conclusion This post-hoc analysis revealed that AMI patients with multivessel disease have both a higher incidence of MACE and an increased risk of bleeding events. These findings highlight the need for a tailored treatment strategy that carefully balances ischemic and bleeding risks, potentially including adjustments in antithrombotic therapy duration and intensity.BARC 3 or 5 bleeding whole period BARC 3 or 5 bleeding after discharge
Nakamura et al. (Sat,) reported a other. AMI patients with multivessel disease had higher 1-year MACE (8.8% vs 3.5%) and bleeding risk (HR 1.42) compared to single-vessel disease patients.