Incidence, Predictors and Associations Between In-Hospital Bleeding and Adverse Events in Patients with Acute Coronary Syndrome Above 75 Years of Age – The Real-World Scenario

Background: Bleeding events in patients with acute coronary syndrome (ACS) are associated with poor outcomes. Risk factors and their associations with in-hospital events in older patients with ACS are not fully understood, because older patients with ACS are often excluded from randomized controlled studies. Methods: We enrolled 962 patients with ACS above 75 years of age treated at our center between January 2012 and December 2016. The incidence and risk factors for in-hospital bleeding events, as well as their associations with in-hospital adverse events were evaluated. Results: Bleeding complications were observed in 38 patients (4.1%). The most common bleeding site was the gastrointestinal tract (52.6%). Anemia (P=0.007), renal insufficiency (P=0.019), use of positive inotropic medicines (P=0.006) and elevated leukocyte count (P=0.046) were independent predictors of in-hospital bleeding after adjustment for age, sex, atrial fibrillation history and hypertension history. In-hospital mortality (28.9% vs. 2.4%, P<0.001), stroke (5.3% vs. 0.5%, P<0.001) and the prevalence of heart failure (39.5% vs. 16.3%, P<0.001) were significantly higher in patients with than without bleeding. Conclusions: The incidence of in-hospital bleeding was 4.1% in patients with ACS above 75 years of age in this cohort. Independent risk factors for in-hospital bleeding events included anemia, renal insufficiency and elevated leucocyte count. Bleeding events were strongly associated with in-hospital adverse events.