A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes
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 pa...
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| creator | Mehran, Roxana, MD Pocock, Stuart J., PhD Nikolsky, Eugenia, MD, PhD Clayton, Tim, MSc Dangas, George D., MD Kirtane, Ajay J., MD Parise, Helen, ScD Fahy, Martin, MSc Manoukian, Steven V., MD Feit, Frederick, MD Ohman, Magnus E., MD Witzenbichler, Bernard, MD Guagliumi, Giulio, MD Lansky, Alexandra J., MD Stone, Gregg W., MD |
| description | 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. |
| doi_str_mv | 10.1016/j.jacc.2009.09.076 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_733134962</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S073510971001288X</els_id><sourcerecordid>733134962</sourcerecordid><originalsourceid>FETCH-LOGICAL-c468t-76a69e2899deb72cf67308ddf7755d1c261a7d2f41944b4a0a5cd2a9c4537c763</originalsourceid><addsrcrecordid>eNp9kl1rFDEUhoModlv9A15IQMSrWZPMJJmAFNalflGwuIrehWxyRjOdndQkI-y_N-OuFnohHEgunnPynocg9ISSJSVUvOyXvbF2yQhRy7mkuIcWlPO2qrmS99GCyJpXlCh5gk5T6gkhoqXqITphhNPC8AX6sMKffLrGGxsi4BzwVQTnbcavByiX8Tv2I74y2cOYE_7q8w-8slMGvA4xjCbu8WY_uhh2kB6hB50ZEjw-nmfoy5uLz-t31eXHt-_Xq8vKNqLNlRRGKGCtUg62ktlOyJq0znVScu6oZYIa6VjXUNU028YQw61jRtmG19JKUZ-hF4e5NzH8nCBlvfPJwjCYEcKUtKxrWjdKsEI-u0P2YYpjCacpJ4IJSVpVKHagbAwpRej0TfS7spqmRM-ida9n0XoWref6E-LpcfS03YH71_LXbAGeHwGTrBm6aEbr0y3HVNmPzBlfHTgoyn55iDrZItsW-RFs1i74_-c4v9NuBz_68uI17CHd7qsT00Rv5i8x_whKCGVt-63-DaG7rjw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1506267089</pqid></control><display><type>article</type><title>A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Mehran, Roxana, MD ; Pocock, Stuart J., PhD ; Nikolsky, Eugenia, MD, PhD ; Clayton, Tim, MSc ; Dangas, George D., MD ; Kirtane, Ajay J., MD ; Parise, Helen, ScD ; Fahy, Martin, MSc ; Manoukian, Steven V., MD ; Feit, Frederick, MD ; Ohman, Magnus E., MD ; Witzenbichler, Bernard, MD ; Guagliumi, Giulio, MD ; Lansky, Alexandra J., MD ; Stone, Gregg W., MD</creator><creatorcontrib>Mehran, Roxana, MD ; Pocock, Stuart J., PhD ; Nikolsky, Eugenia, MD, PhD ; Clayton, Tim, MSc ; Dangas, George D., MD ; Kirtane, Ajay J., MD ; Parise, Helen, ScD ; Fahy, Martin, MSc ; Manoukian, Steven V., MD ; Feit, Frederick, MD ; Ohman, Magnus E., MD ; Witzenbichler, Bernard, MD ; Guagliumi, Giulio, MD ; Lansky, Alexandra J., MD ; Stone, Gregg W., MD</creatorcontrib><description>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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2009.09.076</identifier><identifier>PMID: 20513595</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - drug therapy ; Acute Coronary Syndrome - mortality ; Acute Coronary Syndrome - therapy ; Acute coronary syndromes ; Age ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary - methods ; Biological and medical sciences ; Biomarkers ; bleeding ; Blood products ; Blood transfusions ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cause of Death ; Confidence Intervals ; Coronary Angiography ; Coronary Artery Bypass - methods ; Coronary heart disease ; Electrocardiography ; Female ; Fibrinolytic Agents - adverse effects ; Fibrinolytic Agents - therapeutic use ; Heart ; Heart attacks ; Hemorrhage - chemically induced ; Hemorrhage - mortality ; Heparin - adverse effects ; Heparin - therapeutic use ; Hospital Mortality - trends ; Humans ; Internal Medicine ; Intubation ; Kaplan-Meier Estimate ; Logistics ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Mortality ; Multivariate Analysis ; myocardial infarction ; Myocarditis. Cardiomyopathies ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex - adverse effects ; Platelet Glycoprotein GPIIb-IIIa Complex - therapeutic use ; Predictive Value of Tests ; Probability ; Proportional Hazards Models ; Risk Assessment ; Risk factors ; risk score ; Severity of Illness Index ; Survival Analysis ; Treatment Outcome</subject><ispartof>Journal of the American College of Cardiology, 2010-06, Vol.55 (23), p.2556-2566</ispartof><rights>American College of Cardiology Foundation</rights><rights>2010 American College of Cardiology Foundation</rights><rights>2015 INIST-CNRS</rights><rights>Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Jun 8, 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c468t-76a69e2899deb72cf67308ddf7755d1c261a7d2f41944b4a0a5cd2a9c4537c763</citedby><cites>FETCH-LOGICAL-c468t-76a69e2899deb72cf67308ddf7755d1c261a7d2f41944b4a0a5cd2a9c4537c763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S073510971001288X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22919402$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20513595$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Pocock, Stuart J., PhD</creatorcontrib><creatorcontrib>Nikolsky, Eugenia, MD, PhD</creatorcontrib><creatorcontrib>Clayton, Tim, MSc</creatorcontrib><creatorcontrib>Dangas, George D., MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Manoukian, Steven V., MD</creatorcontrib><creatorcontrib>Feit, Frederick, MD</creatorcontrib><creatorcontrib>Ohman, Magnus E., MD</creatorcontrib><creatorcontrib>Witzenbichler, Bernard, MD</creatorcontrib><creatorcontrib>Guagliumi, Giulio, MD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><title>A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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.</description><subject>Acute Coronary Syndrome - diagnosis</subject><subject>Acute Coronary Syndrome - drug therapy</subject><subject>Acute Coronary Syndrome - mortality</subject><subject>Acute Coronary Syndrome - therapy</subject><subject>Acute coronary syndromes</subject><subject>Age</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty, Balloon, Coronary - methods</subject><subject>Biological and medical sciences</subject><subject>Biomarkers</subject><subject>bleeding</subject><subject>Blood products</subject><subject>Blood transfusions</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cause of Death</subject><subject>Confidence Intervals</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass - methods</subject><subject>Coronary heart disease</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Fibrinolytic Agents - adverse effects</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Heart</subject><subject>Heart attacks</subject><subject>Hemorrhage - chemically induced</subject><subject>Hemorrhage - mortality</subject><subject>Heparin - adverse effects</subject><subject>Heparin - therapeutic use</subject><subject>Hospital Mortality - trends</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Intubation</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistics</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Multivariate Analysis</subject><subject>myocardial infarction</subject><subject>Myocarditis. Cardiomyopathies</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - adverse effects</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - therapeutic use</subject><subject>Predictive Value of Tests</subject><subject>Probability</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Risk factors</subject><subject>risk score</subject><subject>Severity of Illness Index</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kl1rFDEUhoModlv9A15IQMSrWZPMJJmAFNalflGwuIrehWxyRjOdndQkI-y_N-OuFnohHEgunnPynocg9ISSJSVUvOyXvbF2yQhRy7mkuIcWlPO2qrmS99GCyJpXlCh5gk5T6gkhoqXqITphhNPC8AX6sMKffLrGGxsi4BzwVQTnbcavByiX8Tv2I74y2cOYE_7q8w-8slMGvA4xjCbu8WY_uhh2kB6hB50ZEjw-nmfoy5uLz-t31eXHt-_Xq8vKNqLNlRRGKGCtUg62ktlOyJq0znVScu6oZYIa6VjXUNU028YQw61jRtmG19JKUZ-hF4e5NzH8nCBlvfPJwjCYEcKUtKxrWjdKsEI-u0P2YYpjCacpJ4IJSVpVKHagbAwpRej0TfS7spqmRM-ida9n0XoWref6E-LpcfS03YH71_LXbAGeHwGTrBm6aEbr0y3HVNmPzBlfHTgoyn55iDrZItsW-RFs1i74_-c4v9NuBz_68uI17CHd7qsT00Rv5i8x_whKCGVt-63-DaG7rjw</recordid><startdate>20100608</startdate><enddate>20100608</enddate><creator>Mehran, Roxana, MD</creator><creator>Pocock, Stuart J., PhD</creator><creator>Nikolsky, Eugenia, MD, PhD</creator><creator>Clayton, Tim, MSc</creator><creator>Dangas, George D., MD</creator><creator>Kirtane, Ajay J., MD</creator><creator>Parise, Helen, ScD</creator><creator>Fahy, Martin, MSc</creator><creator>Manoukian, Steven V., MD</creator><creator>Feit, Frederick, MD</creator><creator>Ohman, Magnus E., MD</creator><creator>Witzenbichler, Bernard, MD</creator><creator>Guagliumi, Giulio, MD</creator><creator>Lansky, Alexandra J., MD</creator><creator>Stone, Gregg W., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20100608</creationdate><title>A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes</title><author>Mehran, Roxana, MD ; Pocock, Stuart J., PhD ; Nikolsky, Eugenia, MD, PhD ; Clayton, Tim, MSc ; Dangas, George D., MD ; Kirtane, Ajay J., MD ; Parise, Helen, ScD ; Fahy, Martin, MSc ; Manoukian, Steven V., MD ; Feit, Frederick, MD ; Ohman, Magnus E., MD ; Witzenbichler, Bernard, MD ; Guagliumi, Giulio, MD ; Lansky, Alexandra J., MD ; Stone, Gregg W., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c468t-76a69e2899deb72cf67308ddf7755d1c261a7d2f41944b4a0a5cd2a9c4537c763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acute Coronary Syndrome - diagnosis</topic><topic>Acute Coronary Syndrome - drug therapy</topic><topic>Acute Coronary Syndrome - mortality</topic><topic>Acute Coronary Syndrome - therapy</topic><topic>Acute coronary syndromes</topic><topic>Age</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty, Balloon, Coronary - methods</topic><topic>Biological and medical sciences</topic><topic>Biomarkers</topic><topic>bleeding</topic><topic>Blood products</topic><topic>Blood transfusions</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cause of Death</topic><topic>Confidence Intervals</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass - methods</topic><topic>Coronary heart disease</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Fibrinolytic Agents - adverse effects</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Hemorrhage - chemically induced</topic><topic>Hemorrhage - mortality</topic><topic>Heparin - adverse effects</topic><topic>Heparin - therapeutic use</topic><topic>Hospital Mortality - trends</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Intubation</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistics</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Multivariate Analysis</topic><topic>myocardial infarction</topic><topic>Myocarditis. Cardiomyopathies</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - adverse effects</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - therapeutic use</topic><topic>Predictive Value of Tests</topic><topic>Probability</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment</topic><topic>Risk factors</topic><topic>risk score</topic><topic>Severity of Illness Index</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mehran, Roxana, MD</creatorcontrib><creatorcontrib>Pocock, Stuart J., PhD</creatorcontrib><creatorcontrib>Nikolsky, Eugenia, MD, PhD</creatorcontrib><creatorcontrib>Clayton, Tim, MSc</creatorcontrib><creatorcontrib>Dangas, George D., MD</creatorcontrib><creatorcontrib>Kirtane, Ajay J., MD</creatorcontrib><creatorcontrib>Parise, Helen, ScD</creatorcontrib><creatorcontrib>Fahy, Martin, MSc</creatorcontrib><creatorcontrib>Manoukian, Steven V., MD</creatorcontrib><creatorcontrib>Feit, Frederick, MD</creatorcontrib><creatorcontrib>Ohman, Magnus E., MD</creatorcontrib><creatorcontrib>Witzenbichler, Bernard, MD</creatorcontrib><creatorcontrib>Guagliumi, Giulio, MD</creatorcontrib><creatorcontrib>Lansky, Alexandra J., MD</creatorcontrib><creatorcontrib>Stone, Gregg W., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mehran, Roxana, MD</au><au>Pocock, Stuart J., PhD</au><au>Nikolsky, Eugenia, MD, PhD</au><au>Clayton, Tim, MSc</au><au>Dangas, George D., MD</au><au>Kirtane, Ajay J., MD</au><au>Parise, Helen, ScD</au><au>Fahy, Martin, MSc</au><au>Manoukian, Steven V., MD</au><au>Feit, Frederick, MD</au><au>Ohman, Magnus E., MD</au><au>Witzenbichler, Bernard, MD</au><au>Guagliumi, Giulio, MD</au><au>Lansky, Alexandra J., MD</au><au>Stone, Gregg W., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2010-06-08</date><risdate>2010</risdate><volume>55</volume><issue>23</issue><spage>2556</spage><epage>2566</epage><pages>2556-2566</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><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><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>20513595</pmid><doi>10.1016/j.jacc.2009.09.076</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_proquest_miscellaneous_733134962 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - drug therapy Acute Coronary Syndrome - mortality Acute Coronary Syndrome - therapy Acute coronary syndromes Age Aged Aged, 80 and over Angioplasty, Balloon, Coronary - methods Biological and medical sciences Biomarkers bleeding Blood products Blood transfusions Cardiology Cardiology. Vascular system Cardiovascular Cause of Death Confidence Intervals Coronary Angiography Coronary Artery Bypass - methods Coronary heart disease Electrocardiography Female Fibrinolytic Agents - adverse effects Fibrinolytic Agents - therapeutic use Heart Heart attacks Hemorrhage - chemically induced Hemorrhage - mortality Heparin - adverse effects Heparin - therapeutic use Hospital Mortality - trends Humans Internal Medicine Intubation Kaplan-Meier Estimate Logistics Male Medical imaging Medical sciences Middle Aged Mortality Multivariate Analysis myocardial infarction Myocarditis. Cardiomyopathies Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Platelet Glycoprotein GPIIb-IIIa Complex - adverse effects Platelet Glycoprotein GPIIb-IIIa Complex - therapeutic use Predictive Value of Tests Probability Proportional Hazards Models Risk Assessment Risk factors risk score Severity of Illness Index Survival Analysis Treatment Outcome |
| title | A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-03T16%3A52%3A22IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20Risk%20Score%20to%20Predict%20Bleeding%20in%20Patients%20With%20Acute%20Coronary%20Syndromes&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Mehran,%20Roxana,%20MD&rft.date=2010-06-08&rft.volume=55&rft.issue=23&rft.spage=2556&rft.epage=2566&rft.pages=2556-2566&rft.issn=0735-1097&rft.eissn=1558-3597&rft.coden=JACCDI&rft_id=info:doi/10.1016/j.jacc.2009.09.076&rft_dat=%3Cproquest_cross%3E733134962%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1506267089&rft_id=info:pmid/20513595&rft_els_id=S073510971001288X&rfr_iscdi=true |