Incidence, Predictors, and Outcomes of Gastrointestinal Bleeding in Patients Admitted With ST-Elevation Myocardial Infarction

Albeiruti, Ridwaan; Chaudhary, Fahad; Alqahtani, Fahad; Kupec, Justin; Balla, Sudarshan; Alkhouli, Mohamad

doi:10.1016/j.amjcard.2019.05.008

Cited by 23 publications

(19 citation statements)

References 28 publications

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“…A high Killip classification has been associated with increased risk of bleeding [ 3 , 7 , 13 ]. In our study, patients with Killip class IV were at 5.1 times higher risk of in-hospital bleeding than patients with Killip classes I to III.…”

Section: Discussionmentioning

confidence: 99%

“…Advanced age has been reported to be an independent risk factor of bleeding [ 3 , 13 - 17 ]. Age may change the balance between the risks and benefits of treatment strategies [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hemorrhagic complications occur in nearly 8.5% of patients with acute ST-segment elevation myocardial infarction (STEMI) during hospitalization [ 1 , 2 ]. Bleeding events were associated with an increased risk of adverse outcomes in patients with STEMI [ 3 - 7 ]. Prevention of bleeding may represent an achievable step.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Model for In-Hospital Bleeding in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation

2020

JMIR Med Inform

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Background Bleeding complications in patients with acute ST-segment elevation myocardial infarction (STEMI) have been associated with increased risk of subsequent adverse consequences. Objective The objective of our study was to develop and externally validate a diagnostic model of in-hospital bleeding. Methods We performed multivariate logistic regression of a cohort for hospitalized patients with acute STEMI in the emergency department of a university hospital. Participants: The model development data set was obtained from 4262 hospitalized patients with acute STEMI from January 2002 to December 2013. A set of 6015 hospitalized patients with acute STEMI from January 2014 to August 2019 were used for external validation. We used logistic regression analysis to analyze the risk factors of in-hospital bleeding in the development data set. We developed a diagnostic model of in-hospital bleeding and constructed a nomogram. We assessed the predictive performance of the diagnostic model in the validation data sets by examining measures of discrimination, calibration, and decision curve analysis (DCA). Results In-hospital bleeding occurred in 112 of 4262 participants (2.6%) in the development data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. Logistic regression analysis showed differences between the groups with and without in-hospital bleeding in age (odds ratio [OR] 1.047, 95% CI 1.029-1.066; P<.001), Killip III (OR 3.265, 95% CI 2.008-5.31; P<.001), and Killip IV (OR 5.133, 95% CI 3.196-8.242; P<.001). We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic curve (AUC) was 0.777 (SD 0.021, 95% CI 0.73576-0.81823). We constructed a nomogram based on age and Killip classification. In-hospital bleeding occurred in 117 of 6015 participants (1.9%) in the validation data set. The AUC was 0.7234 (SD 0.0252, 95% CI 0.67392-0.77289). Conclusions We developed and externally validated a diagnostic model of in-hospital bleeding in patients with acute STEMI. The discrimination, calibration, and DCA of the model were found to be satisfactory. Trial Registration ChiCTR.org ChiCTR1900027578; http://www.chictr.org.cn/showprojen.aspx?proj=45926

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Section: Discussionmentioning

confidence: 99%

“…Advanced age has been reported to be an independent risk factor of bleeding [ 3 , 13 - 17 ]. Age may change the balance between the risks and benefits of treatment strategies [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Model for In-Hospital Bleeding in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation

2020

JMIR Med Inform

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“…[11] Advanced age has been reported to be an independent risk factor of bleeding. [3,[11][12][13][14][15] Age may change the balance between the risks and benefits of treatment strategies. [16] The cause of the higher risk of bleeding in the elderly may be multifactorial, including decreased kidney function and increased sensitivity to anticoagulants.…”

Section: Discussionmentioning

confidence: 99%

“…[1, 2] Bleeding events are associated with an increased risk of adverse outcomes in patients with STEMI. [3–6] Prevention of bleeding may represent an achievable step. We want to develop and externally validate a diagnostic model of in-hospital bleeding in the population of unselected real-world patients with acute STEMI.…”

Section: Introductionmentioning

confidence: 99%

Development and external validation of a diagnostic model for in-hospital bleeding in patients with acute ST elevation myocardial infarction

Li¹

2020

Preprint

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Background: Bleeding complications in patients with acute ST segment elevation myocardial infarction(STEMI) are associated with an increased risk of subsequent adverse consequences. We want to develop and externally validate a diagnostic model of in-hospital bleeding in the population of unselected real-world patients with acute STEMI. Methods: Design: Multivariable logistic regression of a cohort for hospitalized patients with acute STEMI . Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 4262 hospitalized patients with acute STEMI from January 2002 to December 2013 in Beijing Anzhen Hospital, Capital Medical University. External validation: Totally 6015 hospitalized patients with acute STEMI from January 2014 to August 2019 in Beijing Anzhen Hospital, Capital Medical University. Outcomes: All-cause in-hospital bleeding not related to coronary artery bypass graft surgery or catheterization. Results: In-hospital bleeding occurred in 2.6%(112/4262)of patients in the development data set and 1.9%(117/6015)of patients in the validation data set. The strongest predictors of in-hospital bleeding were advanced age and high Killip classification. We developed a diagnostic model of in-hospital bleeding. The area under the receiver operating characteristic (ROC)curve (AUC) was 0.777 0.021, 95% confidence interval(CI)= 0.73576 ~ 0.81823. We constructed a nomograms using the development database based on age , and Killip classification. The AUC was 0.7234 0.0252, 95% CI= 0.67392 ~ 0.77289 in the validation data set . Discrimination, calibration, and decision curve analysis were satisfactory. Conclusions: We developed and externally validated a moderate diagnostic model of in-hospital bleeding in patients with acute STEMI . We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027578; registered date: 19 Novmober 2019). http://www.chictr.org.cn/edit.aspx?pid=45926&htm=4. Key Words: coronary disease; ST elevation myocardial infarction; hemorrhage; nomogram

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Double Trouble: Reducing Gastrointestinal Bleeding due to DAPT Following Acute Coronary Syndromes

Ayoub

Sengupta

2020

Dig Dis Sci

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Incidence, Predictors, and Outcomes of Gastrointestinal Bleeding in Patients Admitted With ST-Elevation Myocardial Infarction

Cited by 23 publications

References 28 publications

Diagnostic Model for In-Hospital Bleeding in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation

Diagnostic Model for In-Hospital Bleeding in Patients with Acute ST-Segment Elevation Myocardial Infarction: Algorithm Development and Validation

Development and external validation of a diagnostic model for in-hospital bleeding in patients with acute ST elevation myocardial infarction

Double Trouble: Reducing Gastrointestinal Bleeding due to DAPT Following Acute Coronary Syndromes

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