Efficacy of bleeding risk scores in elderly patients with acute coronary syndromes
Albert Ariza-Solé1, Francesc Formiga2, Victoria Lorente1
1Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
Insights
Bleeding risk scores are less accurate in elderly patients with acute coronary syndromes. These scores require re-evaluation for older individuals to improve prediction of major bleeding events.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Risk Prediction
Background:
- Acute coronary syndromes (ACS) are prevalent in the elderly.
- Bleeding complications in ACS patients are linked to adverse outcomes.
- Existing bleeding risk scores lack validation in elderly populations.
Purpose of the Study:
- To evaluate the predictive accuracy of established bleeding risk scores in ACS patients aged 75 years and older.
- To compare the performance of CRUSADE, Mehran, and ACTION scores in elderly versus younger ACS patients.
Main Methods:
- Prospective cohort study of ACS patients.
- In-hospital bleeding assessed using CRUSADE, Mehran, and ACTION definitions.
- CRUSADE, Mehran, and ACTION bleeding risk scores calculated for all patients.
- Predictive ability assessed via logistic regression and ROC analysis.
Main Results:
- Older patients (≥75 years) exhibited higher baseline bleeding risk scores.
- While major bleeding incidence was slightly higher in older patients, the difference was not statistically significant.
- The predictive performance (Area Under the Curve) of CRUSADE and ACTION scores was significantly lower in elderly patients compared to younger patients.
Conclusions:
- Current bleeding risk scores demonstrate suboptimal predictive performance in elderly ACS patients.
- Re-evaluation and potential modification of existing scores are necessary for accurate risk stratification in this demographic.
Introduction And Objectives:
The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged ≥ 75 years.
Methods:
We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves.
Results:
We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were ≥ 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P<.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% vs 3.8%; P=.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P=.027; Mehran: 0.67 in older patients, 0.73 in younger patients; P=.340;
Action:
0.58 in older patients, 0.75 in younger patients; P=.041).
Conclusions:
Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.
More Related Videos
06:16Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
04:05Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Acute Coronary Syndrome V: Nursing Management
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:30Venous Thrombosis IV: Nursing Management
01:30Acute Coronary Syndrome I: Introduction