The Bleeding Risk Score as a Mortality Predictor in Patients with Acute Coronary Syndrome

Abstract

BackgroundIt is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied.ObjectiveThe main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center.MethodsOut of 1,655 patients with ACS (547 with ST-elevation ACS and 1,118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1,416. Mortality information and hemorrhagic complications were also obtained.ResultsAmong the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001).ConclusionsBleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.

Age-Related Difference in the Effect of Acute Hyperglycemia on Myocardial Ischemia-Reperfusion Injury

“…There was a trend toward lesser impact of acute hyperglycemia after ischemiareperfusion injury on infarct size and apoptotic, autophagic protein expression in old aged rats. In accordance with these results, recent retrospective analysis of 2,207 patients with acute myocardial infarction shows that hyperglycemia as independent risk factor for in-hospital mortality has less impact in the elderly patient than in younger patient (<50 yr) 12. Based on these results, it can be seen that we need to make a difference according to age in blood glucose control in patients with coronary artery disease.…”

“…11 However, recent retrospective analysis of 2,207 patients with acute myocardial infarction shows that hyperglycemia has less impact on in-hospital mortality in elderly patient than in younger patient (<50 yr). 12 These results suggest the impact of hyperglycemia on myocardial ischemia-reperfusion injury may be heterogeneous across age-groups and different mechanisms may be involved.…”

Impact of Arterial Access Site on Outcomes After Primary Percutaneous Coronary Intervention

“…12,13 So, how can the results of the present analysis be interpreted in the context of multiple randomized trials demonstrating significant bleeding reductions with radial access? [14][15][16][17][18] Plausible explanations for the lack of difference in outcomes between femoral and radial access could include evolution in contemporary practice and trial-specific differences. First, patient selection for randomization into access site trials may inadvertently lead to a tendency to exclude patients with a higher risk for radial access failure, such as octogenarians, females, and patients with cardiogenic shock, thereby possibly magnifying the beneficial impact of radial access.…”

Transfusion-related Acute Lung Injury in the Perioperative Patient

“…Existing bleeding risk scores and assessment tools can predict transfusion requirements in select surgical populations. 132,133 prevention of Transfusion…”