INCIDENCE AND PREDICTORS OF BLEEDING AFTER CONTEMPORARY THROMBOLYTIC THERAPY FOR MYOCARDIAL-INFARCTION

Background Although the benefit of thrombolytic therapy in reducing mo rtality in acute myocardial infarction is well established, the types of bleeding and risk factors for bleeding are less well described in l arge trials. Methods and Results We analyzed the baseline characterist ics, outcomes, and incidence of bleeding by location, severity, and tr eatment assignment among 41021 patients in the GUSTO-I trial of thromb olysis for acute myocardial infarction. Of the 40903 patients for whom there were complete data, 1.2% suffered severe bleeding and 11.4% exp erienced moderate hemorrhage at a variety of sites. The most common so urces of bleeding were procedure related. The thrombolytic regimen was strongly related to the incidence of bleeding; comparatively more ble eding was seen with the therapies of streptokinase plus intravenous he parin and the streptokinase and tissue plasminogen activator plus intr avenous heparin combination. In multivariate analysis, the four most p owerful independent predictors of hemorrhage were older age, lighter b ody weight, female sex, and African ancestry; they remained the most i mportant predictors of bleeding when multivariate analysis was perform ed on patients who did not undergo invasive procedures. The presence o f serious hemorrhage was associated with other undesirable outcomes (r ecurrent events, left ventricular dysfunction, arrhythmia, or stroke). Conclusions Important predictors of bleeding in this population are i ncreased age, lighter weight, female sex, African ancestry, and experi encing invasive procedures. Other nonhemorrhagic adverse clinical outc omes were associated with moderate and severe bleeding, which was in t urn associated with increased length of hospital stay and mortality at 30 days.