One-year and 5-year transition risks between major bleeding, reinfarction, and death following acute myocardial infarction in England and Wales: a population-based cohort study
Abstract
Aims: There is limited data on the long-term transition risks between major bleeding, reinfarction, and death following acute myocardial infarction (AMI). We examined 1-year and 5-year transition risks of major bleeding, reinfarction, and mortality post-AMI.
Methods and results: We analysed national registry data of AMI patients across England and Wales between 2005 and 2021. Multistate modelling was used to estimate the transition-specific adjusted incidence rates (IRs) across the three outcomes using a six-state model with nine transitions. Out of 837 384 patients included, 19.8% had bleeding, 8.1% reinfarction, and 20.6% death as their first event post- AMI admission. Of those with bleeding, 39.4% died while 49.9% of those with reinfarction died. Overall, females had higher rates of transitioning to any of the five states than males. A reference female patient with median age (76.3 years), at 1-year had an IR of 6.7 (95% CI 6.5–6.9) ×100 person-years (PY) for AMI admission → bleeding transition, 0.2 (95% CI 0.2–0.2) ×100PY for AMI admission → reinfarction, 43.5 (95% CI 41.9–45.2) ×100PY for AMI admission → death, 22.2 (95% CI 20.9–23.5) ×100PY for bleeding → death, and 41.9 (95% CI 38.1–46.0) ×100PY for reinfarction → death. At 5-year, the IRs decreased to 2.1 (95% CI 2.0–2.2) ×100PY, 0.04 (95% CI 0.04–0.05) ×100PY, 17.5 (95% CI 16.9–18.2) ×100PY, 9.7 (95% CI 9.2–10.3) ×100PY, and 17.6 (95% CI 16.0–19.4) ×100PY, respectively. A reference male patient with median age (67.1 years) at 1-year had an IR of 5.2 (95% CI 5.0–5.4) ×100PY for AMI admission → bleeding transition, 0.2 (95% CI 0.2–0.2) ×100PY for AMI admission→ reinfarction, 23.7 (95% CI 22.8–24.6) ×100PY for AMI admission → death, 14.5 (95% CI 13.6–15.4) ×100PY for bleeding → death, and 25.9 (95% CI 23.8–28.3) ×100PY for reinfarction → death. Similarly, 5-year IRs decreased to 1.6 (95% CI 1.6–1.7) ×100PY, 0.04 (95% CI 0.04–0.04) ×100PY, 9.5 (95% CI 9.2–9.9) ×100PY, 6.3 (95% CI 5.9–6.8) ×100PY, and 10.9 (95% CI 10.0–11.9) ×100PY, respectively. Also, those with diabetes and white patients had higher transition rates than those without diabetes and black patients.
Conclusion: In this national AMI cohort, 5-year direct death and bleeding events were more frequent than reinfarction, and the highest mortality occurred in women after AMI admission and in men following reinfarction. These transition patterns quantify the substantial absolute risks patients face post-AMI and highlight important sex-specific differences in adverse outcomes.
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BibTeX
@article{ayayo2026oneyear,
title = {{One-year and 5-year transition risks between major bleeding, reinfarction, and death following acute myocardial infarction in England and Wales: a population-based cohort study}},
author = {Sharon A Ayayo and Glen P Martin and Salwa S Zghebi and Vicky P Taxiarchi and Muhammad Rashid and Evangelos Kontopantelis and Mamas A Mamas},
journal = {European Heart Journal. Acute Cardiovascular Care},
year = {2026},
month = jun,
doi = {10.1093/ehjacc/zuag088},
url = {https://doi.org/10.1093/ehjacc/zuag088},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - One-year and 5-year transition risks between major bleeding, reinfarction, and death following acute myocardial infarction in England and Wales: a population-based cohort study
AU - Sharon A Ayayo
AU - Glen P Martin
AU - Salwa S Zghebi
AU - Vicky P Taxiarchi
AU - Muhammad Rashid
AU - Evangelos Kontopantelis
AU - Mamas A Mamas
PY - 2026
DA - 2026/06/24
JO - European Heart Journal. Acute Cardiovascular Care
DO - 10.1093/ehjacc/zuag088
UR - https://doi.org/10.1093/ehjacc/zuag088
AB - Aims: There is limited data on the long-term transition risks between major bleeding, reinfarction, and death following acute myocardial infarction (AMI). We examined 1-year and 5-year transition risks of major bleeding, reinfarction, and mortality post-AMI. Methods and results: We analysed national registry data of AMI patients across England and Wales between 2005 and 2021. Multistate modelling was used to estimate the transition-specific adjusted incidence rates (IRs) across the three outcomes using a six-state model with nine transitions. Out of 837 384 patients included, 19.8% had bleeding, 8.1% reinfarction, and 20.6% death as their first event post- AMI admission. Of those with bleeding, 39.4% died while 49.9% of those with reinfarction died. Overall, females had higher rates of transitioning to any of the five states than males. A reference female patient with median age (76.3 years), at 1-year had an IR of 6.7 (95% CI 6.5–6.9) ×100 person-years (PY) for AMI admission → bleeding transition, 0.2 (95% CI 0.2–0.2) ×100PY for AMI admission → reinfarction, 43.5 (95% CI 41.9–45.2) ×100PY for AMI admission → death, 22.2 (95% CI 20.9–23.5) ×100PY for bleeding → death, and 41.9 (95% CI 38.1–46.0) ×100PY for reinfarction → death. At 5-year, the IRs decreased to 2.1 (95% CI 2.0–2.2) ×100PY, 0.04 (95% CI 0.04–0.05) ×100PY, 17.5 (95% CI 16.9–18.2) ×100PY, 9.7 (95% CI 9.2–10.3) ×100PY, and 17.6 (95% CI 16.0–19.4) ×100PY, respectively. A reference male patient with median age (67.1 years) at 1-year had an IR of 5.2 (95% CI 5.0–5.4) ×100PY for AMI admission → bleeding transition, 0.2 (95% CI 0.2–0.2) ×100PY for AMI admission→ reinfarction, 23.7 (95% CI 22.8–24.6) ×100PY for AMI admission → death, 14.5 (95% CI 13.6–15.4) ×100PY for bleeding → death, and 25.9 (95% CI 23.8–28.3) ×100PY for reinfarction → death. Similarly, 5-year IRs decreased to 1.6 (95% CI 1.6–1.7) ×100PY, 0.04 (95% CI 0.04–0.04) ×100PY, 9.5 (95% CI 9.2–9.9) ×100PY, 6.3 (95% CI 5.9–6.8) ×100PY, and 10.9 (95% CI 10.0–11.9) ×100PY, respectively. Also, those with diabetes and white patients had higher transition rates than those without diabetes and black patients. Conclusion: In this national AMI cohort, 5-year direct death and bleeding events were more frequent than reinfarction, and the highest mortality occurred in women after AMI admission and in men following reinfarction. These transition patterns quantify the substantial absolute risks patients face post-AMI and highlight important sex-specific differences in adverse outcomes.
SN - 2048-8726
SN - 2048-8734
ER -