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The bleeding risk score as a mortality predictor in patients with acute coronary syndrome
Insights
The bleeding risk score effectively predicts in-hospital mortality in acute coronary syndromes (ACS) patients. This score is particularly reliable for unstable angina and non-ST-elevation myocardial infarction, aiding clinical decision-making.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Acute Coronary Syndromes
Background:
- Bleeding complications are known to increase in-hospital mortality in patients with acute coronary syndromes (ACS).
- While bleeding risk scores correlate with bleeding incidence, their utility as mortality predictors remains understudied.
Purpose of the Study:
- To evaluate the role of bleeding risk score in predicting in-hospital mortality.
- To analyze this predictive role in a cohort of ACS patients treated at a single cardiology tertiary center.
Main Methods:
- The study included 1655 patients with ACS (547 ST-elevation ACS, 1118 non-ST-elevation ACS).
- The ACUITY/HORIZONS bleeding score was calculated prospectively in 249 patients and retrospectively in 1416.
- Mortality data and hemorrhagic complications were collected.
Main Results:
- A significant correlation was found between bleeding and mortality (p < 0.001, OR = 5.296).
- The bleeding score strongly correlated with in-hospital bleeding (p < 0.001, OR = 1.058) and in-hospital mortality (adjusted OR = 1.121, p < 0.001).
- The area under the ROC curve for mortality prediction was 0.753 (p < 0.001), with variations noted between ST-elevation and non-ST-elevation ACS subgroups.
Conclusions:
- The bleeding risk score is a highly useful and reliable predictor of in-hospital mortality in ACS patients.
- The score demonstrates particular utility in patients with unstable angina or non-ST-elevation acute myocardial infarction.
Background:
It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied.
Objective:
The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center.
Methods:
Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained.
Results:
Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001).
Conclusions:
Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.
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