TY - JOUR
T1 - Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry
AU - Garay, Alberto
AU - Ariza-Solé, Albert
AU - Formiga, Francesc
AU - Raposeiras-Roubín, Sergio
AU - Abu-Assi, Emad
AU - Sánchez-Salado, José C.
AU - Lorente, Victòria
AU - Alegre, Oriol
AU - Henriques, Jose Paulo Simao
AU - D'Ascenzo, Fabrizio
AU - Saucedo, Jorge
AU - González-Juanatey, José Ramón
AU - Wilton, Stephen B.
AU - Kikkert, Wouter J.
AU - Nuñez-Gil, Iván
AU - Song, Xiantao
AU - Alexopoulos, Dimitrios
AU - Liebetrau, Christoph
AU - Kawaji, Tetsuma
AU - Moretti, Claudio
AU - Huczek, Zenon
AU - Nie, Shao-Ping
AU - Fujii, Toshiharu
AU - Correia, Luis
AU - Kawashiri, Masa-Aki
AU - García-Acuña, José María
AU - Southern, Danielle
AU - Alfonso, Emilio
AU - Terol, Belén
AU - Zhang, Dongfeng
AU - Chen, Yalei
AU - Xanthopoulou, Ioanna
AU - Osman, Neriman
AU - Möllmann, Helge
AU - Shiomi, Hiroki
AU - Giordana, Francesca
AU - Gaita, Fiorenzo
AU - Kowara, Michal
AU - Filipiak, Krzysztof
AU - Wang, Xiao
AU - Yan, Yan
AU - Fan, Jing-Yao
AU - Ikari, Yuji
AU - Nakahashi, Takuya
AU - Sakata, Kenji
AU - Yamagishi, Masakazu
AU - Kalpak, Oliver
AU - Kedev, Sasko
AU - Cequier, Angel
PY - 2018
Y1 - 2018
N2 - 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.
AB - 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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85045033069&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29614517
U2 - https://doi.org/10.1055/s-0038-1635259
DO - https://doi.org/10.1055/s-0038-1635259
M3 - Article
C2 - 29614517
SN - 0340-6245
VL - 118
SP - 929
EP - 938
JO - Thrombosis and haemostasis
JF - Thrombosis and haemostasis
IS - 5
ER -