Risk score identifies patients at risk for non–CABG-related bleeding, 1-year mortality
A risk score based on six baseline measures plus anticoagulation regimen identified patients at increased risk for non–CABG-related bleeding and subsequent 1-year mortality, study findings suggested.
With hemorrhagic complications strongly linked to subsequent mortality in patients with acute coronary syndromes, researchers for the study sought to develop a practical risk score to predict the risk and implications of major bleeding in ACS.
Study participants included 17,421 patients with ACS from the ACUITY and the HORIZONS-AMI trials. Combining both trial databases, the researchers determined univariate associations of 20 baseline variables and randomized treatment with major bleeding within 30 days and mortality within 1 year.
Non–CABG-related major bleeding within 30 days occurred in 744 patients (7.3%) and had six independent baseline predictors (female sex, advanced age, elevated serum creatinine and white blood cell count, anemia, non-STEMI, or STEMI) and one treatment-related variable (use of heparin and a glycoprotein IIb/IIIa inhibitor rather than bivalirudin [Angiomax, The Medicines Co.] alone; model c-statistic 0.74). In a time-updated covariate-adjusted Cox proportional hazards regression model, major bleeding was an independent predictor of a 3.2-fold increase in mortality.
“We can conclude that for individuals with ACS, there is marked variation in the risk of non–CABG-related major bleeding,” the researchers said. “A practical ACUITY/HORIZONS-AMI scoring system with six readily available baseline clinical and laboratory variables plus the anticoagulation regimen used provides a rapid and reliable tool to predict the rate of non–CABG-related major bleeding in patients with ACS and its impact on subsequent mortality within 1 year.”
In an accompanying editorial, Jeffrey Brinker, MD, of The Johns Hopkins Hospital in Baltimore, said this study showed that bivalirudin is an effective strategy to reduce bleeding risk.
“It would seem important that — accepting bleeding as an ominous predictor of morbidity and mortality — radial artery access for PCI become more widely adopted and used whenever feasible to reduce access site complications including major bleeding,” he wrote. “Although we have been taught much from the bivalirudin trials, there is considerably more to learn about PCI technique and adjunctive pharmacotherapy before its safety and effectiveness can be optimized. We know the score, but the game is not over.”
(Source: CardiologyToday)
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