In-Hospital Major Bleeding During ST-Elevation and Non–ST-Elevation Myocardial Infarction Care: Derivation and Validation of a Model from the ACTION Registry®-GWTG™

Mathews, Robin; Peterson, Eric D.; Chen, Anita Y.; Wang, Tracy Y.; Chin, Chee Tang; Fonarow, Gregg C.; Cannon, Christopher P.; Rumsfeld, John S.; Roe, Matthew T.; Alexander, Karen P.

doi:10.1016/j.amjcard.2010.12.009

Cited by 206 publications

(166 citation statements)

References 12 publications

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“…For major bleeding, these SES variables were also added to the adjustment model along with variables from the ACTION Registry-GWTG major bleeding model, which consisted of age, heart rate, and systolic blood pressure on presentation, baseline Hb, baseline serum Cr, presentation with HF and/or cardiogenic shock, DM, prior peripheral arterial disease, weight, and home warfarin. 20 Odds ratios along with 95% confidence intervals for outcomes were presented, where the reference is white race.…”

Section: Discussionmentioning

confidence: 99%

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Anstey

Thomas

et al. 2016

Clinical Cardiology

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BackgroundRace and sex have been shown to affect management of myocardial infarction (MI); however, it is unclear if such disparities exist in contemporary care of ST‐segment elevation myocardial infarction (STEMI) and non‐ST‐segment elevation myocardial infarction (NSTEMI).HypothesisDisparities in care will be less prevalent in more heavily protocol‐driven management of STEMI than the less algorithmic care of NSTEMI.MethodsData were collected from the ACTION Registry‐GWTG database to assess care differences related to race and sex of patients presenting with NSTEMI or STEMI. For key treatments and outcomes, adjustments were made including patient demographics, baseline comorbidities, and markers of socioeconomic status.ResultsKey demographic variables demonstrate significant differences in baseline comorbidities; black patients had higher incidences of hypertension and diabetes, and women more frequently had diabetes. With few exceptions, rates of acute and discharge medical therapy were similar by race in any sex category in both STEMI and NSTEMI populations. Rates of catheterization were similar by race for STEMI but not for NSTEMI, where both black men and women had lower rates of invasive therapy. Rates of revascularization were significantly lower for black patients in both the STEMI and NSTEMI groups regardless of sex. Rates of adverse events differed by sex, with disparities for death and major bleeding; after adjustment, rates were similar by race within sex comparisons.ConclusionsIn this contemporary cohort, although there are differences by race in presentation and management of MI, heavily protocol‐driven processes seem to show fewer racial disparities.

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Section: Discussionmentioning

confidence: 99%

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Anstey

Thomas

et al. 2016

Clinical Cardiology

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“…We thereafter assessed discharge ticagrelor use stratified by predicted risk of in‐hospital bleeding and mortality (ACTION bleeding5and mortality6 scores, respectively). These scores were previously derived and validated using the ACTION Registry‐GWTG data.…”

Section: Methodsmentioning

confidence: 99%

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Basra¹,

Wang

Simon

et al. 2018

JAHA

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BackgroundTicagrelor is a P2Y12 receptor inhibitor with superior clinical efficacy compared with clopidogrel. However, it is associated with reduced efficacy when combined with a high‐dose aspirin.Methods and ResultsPatients in the acute coronary treatment and intervention outcomes network (ACTION) Registry‐Get With The Guidelines (GWTG) with acute myocardial infarction from October 2013 through December 2014 were included in the study (167 455 patients; 622 sites). We evaluated temporal trends in the prescription of P2Y12 inhibitors, and identified factors associated with ticagrelor use at discharge. Among patients discharged on ticagrelor and aspirin (21 262 patients), we evaluated the temporal trends and independent factors associated with high‐dose aspirin prescription at discharge. Ticagrelor prescription at discharge increased significantly from 12% to 16.7% (P<0.0001). Decreases in prasugrel and clopidogrel use at discharge (15.7%–13.9% and 54.2%–51.1%, respectively, P<0.0001) were also observed. Independent factors associated with preferential ticagrelor prescription at discharge over clopidogrel included younger age, white race, home ticagrelor use, invasive management, and in‐hospital re‐infarction and stroke (P<0.0001 for all), whereas older age, female sex, prior stroke, home ticagrelor use, and in‐hospital stroke (P<0.0001 for all) were associated with preferential ticagrelor prescription at discharge over prasugrel. High‐dose aspirin was used in 3.1% of patients discharged on ticagrelor. Independent factors associated with high‐dose aspirin prescription at discharge included home aspirin use, diabetes mellitus, previous myocardial infarction, previous coronary artery bypass graft, ST‐segment–elevation myocardial infarction, cardiogenic shock, and geographic region (P=0.01).ConclusionsOur contemporary analysis shows a modest but significant increase in the use of ticagrelor and a high rate of adherence to the use of low‐dose aspirin at discharge.

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“…score, 9 and the Acute catheterization and urgent intervention triage strategy and The Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) bleeding risk score. 10 Despite these scores offering quantitative methods for assessing bleeding risk in a broader spectrum of ACS, none of them was developed specially for STEMI patients.…”

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confidence: 99%

Predictive Validity of CRUSADE, ACTION and ACUITY-HORIZONS Bleeding Risk Scores in Chinese Patients With ST-Segment Elevation Myocardial Infarction

Liu

Zheng

Zhao

et al. 2018

Circ J

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Background:The CRUSADE, ACTION and ACUITY-HORIZONS bleeding scores have been derived using Caucasian patients, and little is known about which has the better predictive ability in Chinese patients, especially for patients with STEMI. Methods and Results:We retrospectively analyzed 2,208 consecutive STEMI patients undergoing primary PCI (PPCI). Major bleeding events were defined according to Bleeding Academic Research Consortium criteria (type 3 or 5). Predictive ability of the 3 scores was assessed using logistic regression and AUC. Unadjusted HR for 1-year death were determined on Cox proportional hazard modeling. The major bleeding rate was 2.4%. The AUC of the CRUSADE, ACTION and ACUTIY-HORIZONS models was 0.88 (95% CI: 0.84-0.92), 0.90 (95% CI: 0.87-0.94), and 0.78 (95% CI: 0.87-0.94). The calibration of the ACUTIY-HORIZONS model was not acceptable overall, or in the subgroup of access site (P<0.05). In the high-risk category, 1-year mortality was approximately 4-7-fold greater than in the low-risk category (CRUSADE: HR, 7.27; 95% CI: 3.30-16.02, P<0.001; ACTION: HR, 7.13; 95% CI: 2.19-15.41, P<0.001; ACUITY-HORIZONS: HR, 4.06; 95% CI: 1.62-10.16; P=0.003). Conclusions:The CRUSADE and ACTION scores have greater predictive ability for in-hospital major bleeding than the ACUITY-HORIZONS risk score in Chinese STEMI patients undergoing PPCI. Mortality would increase with the transition from low-to high-risk category in 1 year.

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In-Hospital Major Bleeding During ST-Elevation and Non–ST-Elevation Myocardial Infarction Care: Derivation and Validation of a Model from the ACTION Registry®-GWTG™

Cited by 206 publications

References 12 publications

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Race and Sex Differences in Management and Outcomes of Patients After ST‐Elevation and Non–ST‐Elevation Myocardial Infarct: Results From the NCDR

Ticagrelor Use in Acute Myocardial Infarction: Insights From the National Cardiovascular Data Registry

Predictive Validity of CRUSADE, ACTION and ACUITY-HORIZONS Bleeding Risk Scores in Chinese Patients With ST-Segment Elevation Myocardial Infarction

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