Am Heart J. 2023 May 16:S0002-8703(23)00119-9. doi: 10.1016/j.ahj.2023.05.008. Online ahead of print.
BACKGROUND: T2MI is caused by a mismatch between myocardial oxygen supply and demand. One subset of individuals is T2MI caused by acute hemorrhage. Traditional MI treatments including antiplatelets, anticoagulants, and revascularization can worsen bleeding. In this study, we aim to describe and report clinical outcomes of clinically-adjudicated T2MI patients due to bleeding, stratified by treatment approach.
METHODS: The Mass General Brigham Research Patient Data Registry followed by manual physician adjudication was used to identify individuals with T2MI caused by bleeding between 2009 and 2022. We defined 3 treatment groups: (1) an invasively managed group, (2) a pharmacologic group who received antiplatelet and anticoagulant therapy but no procedures, and (3) a conservatively managed group who received no procedures or anticoagulant/antiplatelet therapy. Baseline characteristics, diagnostic testing, treatment regimens, and clinical outcomes for 30-day, mortality, re-bleeding, and readmission were abstracted and outcomes were compared between treatment groups with chi-squared tests.
RESULTS: We identified 5712 individuals coded as having acute bleeding, of which 1017 (17.8%) were coded as having T2MI during their admission. After manual physician adjudication, 73 individuals (7.2%) met the criteria for T2MI caused by bleeding. Among the individuals with T2MI caused by bleeding, 18 were managed invasively, 39 received pharmacologic therapy alone, and 16 were managed conservatively. The invasively managed group experienced lower mortality rates (5.6% vs 37.5%, p = 0.021) yet higher readmission rates (22.2% vs 0%, p = 0.045) than the conservatively managed group. The pharmacologic group experienced lower mortality rates (10.3% vs 37.5%, p= 0.017) yet higher readmission rates (35.9% vs 0%, p = 0.005) than the conservatively managed group. Finally, there were no differences in terms of re-bleeding episodes between the 3 different groups.
CONCLUSION: Individuals with T2MI associated with acute hemorrhage are a high-risk population. Those patients treated with standard procedures experienced higher readmission but lower mortality rates than patients with conservative management. Although these results are not risk-adjusted and likely reflect treatment-selection bias, they at least raise the possibility of testing ischemia-reduction approaches for such high-risk populations. Future clinical trials are required to validate any treatment strategies for T2MI caused by bleeding.
PMID:37201860 | DOI:10.1016/j.ahj.2023.05.008