1. Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry.
- Author
-
Garay A, Ariza-Solé A, Formiga F, Raposeiras-Roubín S, Abu-Assi E, Sánchez-Salado JC, Lorente V, Alegre O, Henriques JPS, D'Ascenzo F, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Song X, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie SP, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Zhang D, Chen Y, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Gaita F, Kowara M, Filipiak K, Wang X, Yan Y, Fan JY, Ikari Y, Nakahashi T, Sakata K, Yamagishi M, Kalpak O, Kedev S, and Cequier A
- Subjects
- Acute Coronary Syndrome diagnosis, Age Factors, Aged, Asia epidemiology, Brazil epidemiology, Canada epidemiology, Erythrocyte Transfusion, Europe epidemiology, Female, Humans, Incidence, Intracranial Hemorrhages diagnosis, Intracranial Hemorrhages epidemiology, Intracranial Hemorrhages therapy, Male, Middle Aged, Patient Readmission, Prasugrel Hydrochloride adverse effects, Predictive Value of Tests, Registries, Risk Assessment, Risk Factors, Ticagrelor adverse effects, Time Factors, Treatment Outcome, Acute Coronary Syndrome surgery, Clopidogrel adverse effects, Decision Support Techniques, Intracranial Hemorrhages chemically induced, Patient Discharge, Percutaneous Coronary Intervention adverse effects, Platelet Aggregation Inhibitors adverse effects
- Abstract
Background: A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients., Methods: We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine-Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC)., Results: The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92-2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001)., Conclusion: Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients., Competing Interests: None., (Schattauer GmbH Stuttgart.)
- Published
- 2018
- Full Text
- View/download PDF