Document Detail


A risk score to predict bleeding in patients with acute coronary syndromes.
MedLine Citation:
PMID:  20513595     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Roxana Mehran; Stuart J Pocock; Eugenia Nikolsky; Tim Clayton; George D Dangas; Ajay J Kirtane; Helen Parise; Martin Fahy; Steven V Manoukian; Frederick Feit; Magnus E Ohman; Bernard Witzenbichler; Giulio Guagliumi; Alexandra J Lansky; Gregg W Stone
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  55     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-01     Completed Date:  2010-07-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2556-66     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York 10032, USA. rmehran@crf.org
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis,  drug therapy*,  mortality,  therapy
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary / methods
Cause of Death*
Confidence Intervals
Coronary Angiography
Coronary Artery Bypass / methods
Electrocardiography
Female
Fibrinolytic Agents / adverse effects*,  therapeutic use
Hemorrhage / chemically induced*,  mortality*
Heparin / adverse effects,  therapeutic use
Hospital Mortality / trends
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors / adverse effects*,  therapeutic use
Platelet Glycoprotein GPIIb-IIIa Complex / adverse effects,  therapeutic use
Predictive Value of Tests
Probability
Proportional Hazards Models
Risk Assessment
Severity of Illness Index
Survival Analysis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 9005-49-6/Heparin
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Jun 8;55(23):2567-9   [PMID:  20513596 ]

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