Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Bleeding risk with acute myocardial infarction
Dodson JA et al. JACC Cardiovasc Interv. 2018 Nov 26;11:2287-96
Key clinical point: Frail older patients with acute myocardial infarction may be at increased bleeding risk if managed with an invasive strategy.
Major finding: Frailty was associated with increased risk of bleeding, with odds ratios of 1.33 and 1.40, compared with fit or well patients.
Study details: Analysis including 129,330 AMI patients in a U.S. registry who were at least 65 years of age.
Disclosures: Researchers reported support from the National Institutes of Health/National Institute on Aging, as well as other disclosures related to Bayer, Janssen, Abbott Vascular, Jarvik Heart, LifeCuff Technologies, and Ancora Heart.
Dodson JA et al. JACC Cardiovasc Interv. 2018 Nov 26;11:2287-96.
This analysis is important and has clinical implications beyond those of previous analyses linking frailty to poor outcomes in patients with cardiovascular disease, according to John A. Bittl, MD.
“The present study helps to transform the rote recording of frailty from a mere quality metric in the medical record into an actionable diagnosis,” Dr. Bittl said in an editorial comment on the findings.
Results of the study show an association between invasive cardiac procedures and increased bleeding in frail patients with AMI.
The benefits of an invasive procedure might be outweighed by the incremental risk added by frailty in older AMI patients at low to moderate risk of poor outcomes, Dr. Bittl suggested.
By contrast, frail older AMI patients at high risk for poor outcomes might be better candidates for an invasive procedure if they can undergo a transradial approach, he said, noting that in the study by Dodson and colleagues, only 26% of frail patients received radial access despite randomized trials showing the approach reduces risk of bleeding.
“In this way, diagnosing frailty in a patient with AMI facilitates clinical decision making and helps to personalize an approach to optimize outcomes,” Dr. Bittl concluded.
Dr. Bittl is with the Interventional Cardiology Group, Florida Hospital Ocala (Fla.) He reported no relationships relevant to his editorial comment ( JACC Cardiovasc Interv. 2018 Nov 26;11[2];2297-93 ).