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A risk score to predict bleeding in patients with acute coronary syndromes.
J Am Coll Cardiol. 2010 Jun 08; 55(23):2556-66.JACC

Abstract

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+Show Affiliations

Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York 10032, USA. rmehran@crf.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20513595

Citation

Mehran, Roxana, et al. "A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes." Journal of the American College of Cardiology, vol. 55, no. 23, 2010, pp. 2556-66.
Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556-66.
Mehran, R., Pocock, S. J., Nikolsky, E., Clayton, T., Dangas, G. D., Kirtane, A. J., Parise, H., Fahy, M., Manoukian, S. V., Feit, F., Ohman, M. E., Witzenbichler, B., Guagliumi, G., Lansky, A. J., & Stone, G. W. (2010). A risk score to predict bleeding in patients with acute coronary syndromes. Journal of the American College of Cardiology, 55(23), 2556-66. https://doi.org/10.1016/j.jacc.2009.09.076
Mehran R, et al. A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2010 Jun 8;55(23):2556-66. PubMed PMID: 20513595.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A risk score to predict bleeding in patients with acute coronary syndromes. AU - Mehran,Roxana, AU - Pocock,Stuart J, AU - Nikolsky,Eugenia, AU - Clayton,Tim, AU - Dangas,George D, AU - Kirtane,Ajay J, AU - Parise,Helen, AU - Fahy,Martin, AU - Manoukian,Steven V, AU - Feit,Frederick, AU - Ohman,Magnus E, AU - Witzenbichler,Bernard, AU - Guagliumi,Giulio, AU - Lansky,Alexandra J, AU - Stone,Gregg W, PY - 2009/07/02/received PY - 2009/09/16/revised PY - 2009/09/19/accepted PY - 2010/6/2/entrez PY - 2010/6/2/pubmed PY - 2010/7/2/medline SP - 2556 EP - 66 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 55 IS - 23 N2 - 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. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/20513595/A_risk_score_to_predict_bleeding_in_patients_with_acute_coronary_syndromes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(10)01288-X DB - PRIME DP - Unbound Medicine ER -