Assessing Bleeding Risk in Acute Coronary Syndromes

Erdem, Güliz; Flather, Marcus

doi:10.1016/j.rec.2011.08.006

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…PCI for NSTEACS was (1) urgent, i.e., done within 2 hours after admission for ongoing chest pain, hemodynamic instability, life-threatening ventricular arrhythmia, or heart failure, (2) early invasive; within 24 hours after admission, or (3) invasive; within 24–72 hours after admission.…”

Section: Methodsmentioning

confidence: 99%

“…PCI was indicated for either ACS or stable coronary disease (SC). ACS was classified as ( 1 ) acute ST-segment elevation myocardial infarction (STEMI); defined by the presence of cardiac ischemic chest pain, ST-segment elevation of >2 mm in at least 2 contiguous leads on the 12-lead electrocardiogram (ECG), and elevated cardiac biomarkers (troponin or creatinine kinase-myocardial band) greater than the upper limit of the normal, or ( 2 ) non-ST elevation ACS (NSTEACS), which included non ST-segment elevation MI (NSTEMI); defined by the presence of cardiac ischemic chest pain, ST-segment depression, inverted T wave or normal ECG, and elevated cardiac biomarkers as above, and ( 3 ) unstable angina (UA); defined by the presence of ischemic cardiac pain, ST-segment depression, inverted T wave or normal ECG, and no elevation of cardiac biomarkers on admission and 8–12 hours later. SC was defined by the presence of either ( 1 ) chronic stable angina (CSA); i.e., ischemic cardiac pain on effort that did not change in severity for the past 3 months, and absence of resting ECG ischemic changes or elevated cardiac biomarkers, or ( 2 ) silent ischemia (SI); defined by the absence of angina in the presence of signs of myocardial ischemia on ECG, echocardiography, or nuclear myocardial scan.…”

Section: Methodsmentioning

confidence: 99%

“…PCI for STEMI was ( 1 ) primary, i.e., PCI as reperfusion strategy with no thrombolysis, ( 2 ) rescue; after failure of thrombolysis, or ( 3 ) elective; after successful thrombolysis. PCI for NSTEACS was ( 1 ) urgent, i.e., done within 2 hours after admission for ongoing chest pain, hemodynamic instability, life-threatening ventricular arrhythmia, or heart failure, ( 2 ) early invasive; within 24 hours after admission, or ( 3 ) invasive; within 24–72 hours after admission.…”

Section: Methodsmentioning

confidence: 99%

“…Bleeding is the most important non-ischemic complication after percutaneous coronary intervention (PCI) and can potentially lead to significant mortality and morbidity ( 1 – 3 ). Predicting the risk of major bleeding events in patients undergoing PCI is an essential component of an effective and safe PCI procedure ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

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Major bleeding events in Jordanian patients undergoing percutaneous coronary intervention (PCI): Incidence, associated factors, impact on prognosis, and predictability of the CRUSADE bleeding risk score. Results from the First Jordanian PCR (PCR1)

Jarrah

Hammoudeh²,

Okkeh³

et al. 2017

Anatol J Cardiol

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Objective:Determine the incidence of major bleeding events, their risk factors, and their impact on prognosis in Jordanian patients undergoing percutaneous coronary intervention (PCI). Evaluate the ability of the CRUSADE bleeding risk score (BRS) to predict major bleeding.Methods:Major bleeding events were defined according to the CRUSADE classification and their incidence was evaluated from hospital admission to one year of follow up. The CRUSADE bleeding risk score was calculated for each patient during the index admission. Incidence of major bleeding events was evaluated in each of the bleeding score quintiles. JoPCR1 is a prospective, observational, multicenter registry of consecutive patients who underwent PCI at 12 tertiary care centers in Jordan. A case report form was used to record data prospectively at hospital admission, at discharge, and at 1 and 12 months of follow-up.Results:The study included 2426 consecutive patients who underwent PCI. During the index hospitalization, major and minor bleeding events occurred in 0.95% and 2.6% of patients, respectively. Multivariate analysis showed that only two variables were significantly associated with major bleeding: female gender (OR=3.7; 95% CI 1.6, 8.5; p=0.002) and past history of cardiovascular disease (OR=2.6; 95% CI 1.1, 5.9; p=0.026). Patients who had in-hospital major bleeding events had higher cardiac mortality during index hospitalization (13.0% vs. 0.7%, p<0.005) and at one year of follow up (13.0% vs. 1.8%, p<0.005) compared to those who had no such events. Receiver operating characteristic curve analysis showed that the CRUSADE BRS has a high ability to predict major bleeding.Conclusion:Major bleeding events were uncommon in this ME registry of a contemporary cohort of patients undergoing PCI but were associated with a higher mortality rate compared with those who did not have major bleeding events. CRUSADE BRS was highly predictive of the incidence of major bleeding events.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Major bleeding events in Jordanian patients undergoing percutaneous coronary intervention (PCI): Incidence, associated factors, impact on prognosis, and predictability of the CRUSADE bleeding risk score. Results from the First Jordanian PCR (PCR1)

Jarrah

Hammoudeh²,

Okkeh³

et al. 2017

Anatol J Cardiol

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show abstract

“…Early invasive strategies in high-risk patients are proving better results. However, these invasive therapies have their own risks, namely bleeding and blood transfusion 1, 2…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of bleeding among Egyptian patients presenting with acute coronary syndrome: Using CRUSADE risk score

Morttada

Shahin

2018

The Egyptian Heart Journal

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BackgroundEarly invasive strategies; in management of acute coronary syndrome; has led to improvement of patient outcomes. However, these invasive therapies have their own risks, namely bleeding and blood transfusion.The aim of this study was to determine the incidence of bleeding, its location and severity among the study population, to correlate between the patients' characteristics and the risk profile of the patients based upon the CRUSADE risk score and increased bleeding events, and lastly; to identify the predictors of increased bleeding risk among Egyptian patients who presented with acute coronary syndrome.MethodsThe study had included eight hundred and twenty-three patients referred to coronary care unit (CCU), to (Ain Shams University hospital, Specialized Ain Shams hospital, and 6th October insurance hospital) with diagnosis of Acute Coronary Syndrome “ACS” within a period from 1/2014 till 7/2014, and they were followed up for additional three months following discharge with assessment of their bleeding risk and risk scores.ResultsMore bleeding events had been witnessed among the study population who were older, diabetics, had renal impairment, had peripheral vascular disease, had congestive heart failure picture at presentation; more among female sex category and more among patients receiving GPIIbIIIa antagonists. Those bleeding events had been experienced during hospital stay.ConclusionRisk of bleeding can be evaluated using a simple risk score in both STEMI & NSTEMI patients, and across anti-coagulant strategies, providing important prognostic information. Variability in the rates of bleeding is likely based on differences in baseline characteristics, comorbidities, and invasive treatment strategies rather than specific anti-coagulation regimens. Patients at highest risk of bleeding are also at highest risk of ischaemia and thrombotic complications. Thus higher risk patients need a more careful treatment approach to maximize the efficacy of therapy and to reduce thrombotic risk while reducing the bleeding risk.

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Are We Optimizing the Use of Dual Antiplatelet Therapy in Patients Hospitalized with Acute Myocardial Infarction?

Hariri

Lessard

Gore

et al. 2020

Cardiovascular Revascularization Medicine

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Background-Dual antiplatelet therapy (DAPT) is a mainstay treatment for hospital survivors of an acute myocardial infarction (AMI). However, there are limited data on the prescribing patterns of DAPT among patients hospitalized with AMI during recent years.Objective-To examine decade-long trends (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) in the use of DAPT versus antiplatelet monotherapy and patient characteristics associated with DAPT use. Methods-The study population consisted of 2,389 adults hospitalized with an initial AMI at all 11 central Massachusetts medical centers on a biennial basis between 2001 and 2011. DAPT was defined as the discharge use of aspirin plus either clopidogrel or prasugrel. Logistic regression analysis was used to identify patient characteristics associated with DAPT use. Results-The average age of the study population was 65 years, and 69% of patients were discharged on DAPT. The use of DAPT at the time of hospital discharge increased from 49% in 2001 to 74% in 2011; this increasing trend was seen across all age groups, both sexes, types of AMI, and in those who underwent a PCI. After multivariable adjustment, patients 65-74 years old (adjusted odds ratio (aOR = 0.53, 95% CI: 0.36 -0.80) and those who underwent coronary artery bypass surgery (aOR = 0.11, 95% CI: 0.07 -0.18) were less likely to have received DAPT, while men (aOR = 14.60, 95% CI: 10.66 -19.98) and those who underwent cardiac catheterization and stenting (aOR= 14.60, 95% CI: 10.66 -19.98) were significantly more likely to have received DAPT at discharge than respective comparison groups.Conclusions-Between 2001 and 2011, the use of DAPT increased markedly among patients hospitalized with AMI. However, a significant proportion of patients were not discharged on this

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Assessing Bleeding Risk in Acute Coronary Syndromes

Cited by 13 publications

References 20 publications

Major bleeding events in Jordanian patients undergoing percutaneous coronary intervention (PCI): Incidence, associated factors, impact on prognosis, and predictability of the CRUSADE bleeding risk score. Results from the First Jordanian PCR (PCR1)

Major bleeding events in Jordanian patients undergoing percutaneous coronary intervention (PCI): Incidence, associated factors, impact on prognosis, and predictability of the CRUSADE bleeding risk score. Results from the First Jordanian PCR (PCR1)

Incidence and predictors of bleeding among Egyptian patients presenting with acute coronary syndrome: Using CRUSADE risk score

Are We Optimizing the Use of Dual Antiplatelet Therapy in Patients Hospitalized with Acute Myocardial Infarction?

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