A risk score to predict bleeding in patients with acute coronary syndromes.
By R. Mehran, Stuart J. Pocock, E. Nikolsky, T. Clayton, G. Dangas, A. Kirtane, H. Parise, M. Fahy, S. Manoukian, F. Feit and 5 more. Journal of the American College of Cardiology, 2010
682 citations recorded by the source corpus.
OBJECTIVES The aim of this study was to develop a practical risk score to predict the risk and implications of major bleeding in acute coronary syndromes (ACS). BACKGROUND Hemorrhagic complications have been strongly linked with subsequent mortality in patients with ACS. METHODS A total of 17,421 patients with ACS (including non-ST-segment elevation myocardial infarction [MI], ST-segment elevation MI, and biomarker negative ACS) were studied in the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) and the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trials. An integer risk score for major bleeding within 30 days was developed from a multivariable logistic regression model. RESULTS Non-coronary artery bypass graft surgery (CABG)-related major bleeding within 30 days occurred in 744 patients (7.3%) and had 6 independent baseline predictors (female sex, advanced age, elevated serum creatinine and white blood cell count, anemia, non-ST-segment elevation MI, or ST-segment elevation MI) and 1 treatment-related variable (use of heparin + a glycoprotein IIb/IIIa inhibitor rather than bivalirudin alone) (model c-statistic = 0.74). The integer risk score differentiated patients with a 30-day rate of non-CABG-related major bleeding ranging from 1% to over 40%. In a time-updated covariate-adjusted Cox proportional hazards regression model, major bleeding was an independent predictor of a 3.2-fold increase in mortality. The link to mortality risk was strongest for non-CABG-related Thrombolysis In Myocardial Infarction (TIMI)-defined major bleeding followed by non-TIMI major bleeding with or without blood transfusions, whereas isolated large hematomas and CABG-related bleeding were not significantly associated with subsequent mortality. CONCLUSIONS Patients with ACS have marked variation in their risk of major bleeding. A simple risk score based on 6 baseline measures plus anticoagulation regimen identifies patients at increased risk for non-CABG-related bleeding and subsequent 1-year mortality, for whom appropriate treatment strategies can be implemented.
Subfields: Cardiology and Cardiovascular Medicine
View Paper: https://www.semanticscholar.org/paper/cc1a7d9150b65b61761f8a4f594daed7b7f8acd4
How researchers see this paper
The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.
- N. Wenger
- L. Mehta
- Glenn N. Levine
- S. Al‐Khatib
- E. Bates
- K. Watson
- Theresa M. Beckie
- J. Joglar
Citations in the corpus
- [2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS.] (2018, neutral): “mortality was comparable in previous studies [11, 138].”
- 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. (2016, background): “For practical purposes, because the relevant aspirin dose available in the United States is apy in Patients With CAD Treated With DAPT TABLE 4 Clinical and Procedural Factors Associated With Increased Ischemic Risk (Including Stent Thrombosis) or Increased Bleeding Risk (62–70) Increased Ischemic Ri”
- Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association (2016, background): “occur more frequently in women, even when weight-adjusted antithrombin agents are used,(229,230) and female sex remains an independent predictor of bleeding.(231)”