Predictors of major bleeding in acute coronary syndromes: the global registry of acute coronary events (GRACE)

Bleeding Complications in Acute Coronary Syndromes and Percutaneous Coronary Intervention: Predictors, Prognostic Significance, and Paradigms for Reducing Risk

“…13 Similarly, a history of renal insufficiency (defined as any documented history of renal compromise) was associated with a significant 1.48-fold increased risk of bleeding (p = 0.0004) among 24,045 patients with ACS from the GRACE (Global Registry of Acute Coronary Events) registry. 15 The impact of renal impairment on bleeding risk is at least partly confounded by the fact that patients with renal impairment tend to be older, female, and have comorbid conditions such as hypertension, peripheral vascular disease, cerebrovascular disease, and heart failure. 14 Additionally, elderly patients may have nearnormal serum creatinine levels but still have impaired renal function.…”

The impact of bleeding in patients with acute coronary syndromes: How to optimize the benefits of treatment and minimize the risk

“…Registries of patients with ACS have shown that major bleeding is associated with a 60% increase in in-hospital death (11,12) and a fivefold increase in one-year mortality (35.9% versus 7.4% in patients without major bleeding) (12). Oneyear myocardial infarction rates were also almost five times higher in the patients with major bleeding (12).…”

The Challenge of Defining Bleeding Among Patients with Acute Coronary Syndromes

“…In this registry, major bleeding was defined as follows: (i) life-threatening bleeding requiring transfusion of 2 U of packed red blood cells (PRBCs); (ii) death; (iii) absolute decrease in hematocrit of 10%; (iv) subdural hematoma; or (v) hemorrhagic cerebrovascular accident. 8 The incidence of major bleeding in GRACE was 4.8% in patients with ST-segment-elevation MI (STEMI), 4.7% in patients with non-ST-segmentelevation MI (NSTEMI), and 2.3% in patients with unstable angina. Predictors of bleeding included patient characteristics such as advanced age, female gender, medical history (i.e., renal insufficiency and bleeding history), presenting characteristics such as hypotension and right-heart catheterization, and therapies such as diuretics, intravenous inotropic agents, vasodilators, and GPIs.…”