Temporal Trends in In-Hospital Bleeding and Transfusion in a Contemporary Canadian ST Elevation Myocardial Infarction Patient Population

• Author / Creator

  Das, Debraj

• Background:
  Although ST-elevation myocardial infarction (STEMI) management has evolved substantially over the last decade, its impact on bleeding and transfusion rates are largely unknown in a ‘real-world’ Canadian population. Using a large Canadian population health database, we evaluated the temporal trends of in-hospital bleeding and transfusion rates in a contemporary Canadian STEMI population.

  Methods:
  Data from the Canadian Institute for Health Information (CIHI) included patients 20 years of age hospitalized for STEMI between April 2007 and March 2016 across all Canadian hospitals, except Quebec. Patients who underwent coronary artery bypass grafting (CABG) during hospitalization were excluded. International Classification of Diseases-10th Revision codes were used to determine STEMI episodes, identify in-hospital bleeding events, and comorbidities. The CIHI database also contained details on patients receiving transfusion during hospitalizations. Associations between bleeding or transfusion and in-hospital death or 30-day readmission with bleeding or transfusion were also reported.

  Results:
  Using 115,078 STEMI episodes, rates of in-hospital bleeding and transfusion declined between 2007 and 2016 from 4.0% to 2.8% (p<0.0001) and 4.7% to 3.8% (p<0.0001), respectively. However, variation in bleeding and transfusion rates were observed across Canadian provinces. Patients who experienced bleeding, or received a transfusion, were older, female, and more commonly had diabetes, hypertension, or heart failure. Compared to patients who did not bleed or receive a transfusion, individuals who bled, or those who were transfused, or those who bled and were transfused, had increased median length of stay (7 days, 11 days, and 14 days, respectively [p<0.0001]). These groups also had higher in-hospital mortality (19.4%, 31.1%, and 30.7%, respectively [p<0.0001]).

  Conclusion
  In summary, the proportion of Canadian STEMI patients experiencing in-hospital bleeding and transfusion have decreased over the past nine years. Further exploration is required to identify the practice patterns used to protect patients from bleeding events and excessive transfusions.

• Subjects / Keywords

  • Transfusion
  • Canadian Population
  • Bleeding
  • Myocardial Infarction

• Graduation date

  Fall 2019

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-a4k0-gk04

• License

  Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.