A risk score to predict bleeding in patients with acute coronary syndromes
Randomized controlled trial published in J Am Coll Cardiol (2010)
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.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
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).
Why This Matters for Hirudotherapy
This study developed an integer risk score to predict 30-day major bleeding in 17,421 patients with acute coronary syndromes from the ACUITY and HORIZONS-AMI trials, identifying six baseline predictors and one treatment-related variable — use of heparin plus a glycoprotein IIb/IIIa inhibitor rather than bivalirudin alone. The risk score differentiated patients with bleeding rates ranging from 1% to over 40%, and major bleeding was independently associated with a 3.2-fold increase in mortality. The abstract mentions bivalirudin as a comparator anticoagulant but provides no information linking it to leeches, hirudin, or hirudotherapy. Consequently, the article's relevance to ASH's domain is not established by the abstract.
Citation
A risk score to predict bleeding in patients with acute coronary syndromes.
Mehran R et al. · J Am Coll Cardiol, 2010
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