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Development and Validation of Prognostic Models for Bleeding and Ischemia in Elderly Patients With Comorbid Acute
Honghong Zhang1,2, Li Zheng1,3, Zengao Yang1,4
1Department of Cardiology, The Sixth Medical Centre Chinese PLA General Hospital Beijing China.
Insights
New prognostic models predict bleeding and ischemia in elderly patients with acute coronary syndrome and atrial fibrillation. These tools aid clinical decisions for high-risk cardiovascular patients.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Research
Background:
- Acute coronary syndrome (ACS) and atrial fibrillation (AF) are prevalent in elderly individuals.
- Comorbidities in this population increase risks of bleeding and ischemia.
- A need exists for prognostic models to quantify these risks in elderly ACS and AF patients.
Purpose of the Study:
- To develop and validate prognostic models for predicting bleeding and thromboembolic events.
- To provide tools for individualized risk assessment in elderly patients with ACS and AF.
- To improve clinical decision-making for managing bleeding and ischemic risks.
Main Methods:
- Retrospective cohort study including 1851 elderly patients (≥65 years) with ACS and AF.
- Development cohort (1252 patients) and two external validation cohorts (284 and 315 patients).
- 1-year follow-up to observe bleeding (BARC 3 or 5) and thromboembolic events; model performance assessed using concordance index, calibration, and decision curve analysis.
Main Results:
- The developed models demonstrated good predictive performance with concordance indexes for bleeding ranging from 0.737 to 0.845 and for ischemia from 0.723 to 0.777 in the development cohort.
- Validation cohorts showed comparable performance (concordance indexes 0.679–0.809).
- Models outperformed conventional methods and showed adequate calibration and clinical utility, with significant Kaplan-Meier differences (log-rank P<0.001).
Conclusions:
- Two robust prognostic models were developed using easily accessible clinical factors.
- These models effectively predict bleeding and ischemia in elderly patients with ACS and AF.
- Online calculators are available to support individualized risk evaluation and clinical decision-making.
Background:
Acute coronary syndrome and atrial fibrillation are common cardiovascular diseases in elderly individuals. Patients with comorbidities face increased risks of bleeding and ischemia; however, there is a lack of prognostic models for quantifying these risks in this special population.
Methods And Results:
In this retrospective cohort study, 1851 patients (≥65 years old) with acute coronary syndrome and atrial fibrillation from 2 hospitals in China were included in the development cohort (1252 individuals) and 2 external validation cohorts (284 and 315 individuals). During 1-year follow-up, 96 Bleeding Academic Research Consortium type 3 or 5 bleeding events and 245 thromboembolic events were observed. In the development cohort, the concordance indexes for bleeding at 3, 6, and 12 mo ranged from 0.737 to 0.845 and for ischemia ranged from 0.723 to 0.777. The calibration curve and decision curve analysis indicated adequate calibration and clinical practicability. The concordance indexes varied from 0.679 to 0.809 in the validation cohorts. Subgroup analyses focusing on anticoagulant drugs and antithrombotic therapy were conducted, revealing similar discrimination and calibration. Kaplan-Meier curves demonstrated significant differences (log-rank P<0.001). Additionally, the models outperformed conventional models in concordance indexes, integrated discrimination improvement, and net reclassification improvement.
Conclusions:
Our study provides 2 robust prognostic models with easily available clinical factors for predicting bleeding and ischemia in elderly patients with acute coronary syndrome and atrial fibrillation. Furthermore, we provide online calculators to facilitate individualized risk evaluation and clinical decision-making.
Registration:
URL: www.chictr.org.cn/. Unique Identifier: ChiCTR2200067185.
