Accuracy of bleeding scores for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13 759 patients

Abstract

IntroductionDue to its negative impact on prognosis, a clear assessment of bleeding risk for patients presenting with acute coronary syndrome (ACS) remains crucial. Different risk scores have been proposed and compared, although with inconsistent results.AimWe performed a meta-analysis to evaluate the accuracy of different bleeding risk scores for ACS patients.Material and methodsAll studies externally validating risk scores for bleeding for patients presenting with ACS were included in the present review. Accuracy of risk scores for external validation cohorts to predict major bleeding in patients with ACS was the primary end point. Sensitivity analysis was performed according to clinical presentation (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)).ResultsNine studies and 13 759 patients were included. CRUSADE, ACUITY, ACTION and GRACE were the scores externally validated. The rate of in-hospital major bleeding was 7.80% (5.5–9.2), 2.05% (1.5–3.0) being related to access and 2.70% (1.7–4.0) needing transfusions. When evaluating all ACS patients, ACTION, CRUSADE and ACUITY performed similarly (AUC 0.75: 0.72–0.79; 0.71: 0.64–0.80 and 0.71: 0.63–0.77 respectively) when compared to GRACE (0.66; 0.64–0.67, all confidence intervals 95%). When appraising only STEMI patients, all the scores performed similarly, while CRUSADE was the only one externally validated for NSTEMI. For ACTION and ACUITY, accuracy increased for radial access patients, while no differences were found for CRUSADE.ConclusionsACTION, CRUSADE and ACUITY perform similarly to predict risk of bleeding in ACS patients. The CRUSADE score is the only one externally validated for NSTEMI, while accuracy of the scores increased with radial access.

The ACEF (age, creatinine, ejection fraction) score predicts ischemic and bleeding outcomes of patients with acute coronary syndromes treated conservatively

“…However, the performance of the ACEF score itself in the context of non-ischemic events in ACS, especially in patients treated conservatively during the index hospital stay, has not been previously tested. The observed AUC of 0.72 for bleeding requiring blood transfusion seems to be comparable to the values reported for other bleeding risk scores [ 15 ], but it should be confirmed in other cohorts. The ACEF score may have a limited value for the selection of patients with the highest benefit of an invasive strategy in patients with non-ST-segment ACS, as symptoms of the ongoing ischemia and/or haemodynamic instability may be more important for the decision-making process.…”

“…These findings were somewhat expected, as two of three components of the ACEF score, i.e. age and serum creatinine level, are strong predictors of ischemic and bleeding events in the setting of ACS [ 1 , 2 , 15 , 16 ]. However, the performance of the ACEF score itself in the context of non-ischemic events in ACS, especially in patients treated conservatively during the index hospital stay, has not been previously tested.…”

Antiplatelet therapy after PCI in patients with high risk of bleeding

“…The HAS-BLED score is another system that, although it is intended to assess the risk of bleeding in patients with atrial fibrillation treated with anticoagulants, is particularly useful in patients with acute coronary syndrome (ACS) (Pisters et al 2010) It is easy to administer and includes important variables such as alcohol use, liver dysfunction, and a previous history of bleeding. (Hsieh et al 2015;Taha et al 2015) The authors of the PRECISE-DAPT score use individualized data from eight randomized controlled trials to develop a hemorrhagic risk assessment system that determines the duration of DAPT in patients who have indications to receive such therapy. Compared to previous scores, the PRECISE-DAPT score is the only that offers long-term stratification of bleeding risk and also takes into account the variable "prior bleeding", which weighs four times more than other variables in the assessment.…”

Evaluation of Bleeding Risk in Patients with Acute Myocardial Infarction Undergoing Transradial Percutaneous Coronary Intervention

“…A comprehensive assessment revealed minor differences in the results, and a meta-analysis also suggested that ACTION, CRUSADE, and ACUITY-HORIZONS similarly performed while predicting the risk of bleeding in patients with AMI. 10) Initially, all these RS systems were developed in patient cohorts in whom the femoral approach was predominantly used, and none has been confirmed for the use with the radial approach, which now constitutes the recommended access site in coronary angiography and PCI for AMI. 6) In this study, we observed that the ACUITY-HORIZONS RS performed better than the CRUSADE and ACTION systems in terms of the predictive ability for 30day major bleeding, although Abu-Assi, et al reported the CRUSADE score as the most accurate quantitative tool for predicting bleeding during hospitalization in patients with NSTEACS and STEMI compared with the ACTION and ACUITY-HORIZONS scores.…”