Faculty Collaboration Database

Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry. Thromb Haemost 2018 May;118(5):929-938

Date

04/04/2018

Pubmed ID

29614517

DOI

10.1055/s-0038-1635259

Scopus ID

2-s2.0-85045033069 (requires institutional sign-in at Scopus site)   21 Citations

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.

Author List

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, Cequier A

Author

Jorge Saucedo MD Chief, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Coronary Syndrome
Age Factors
Aged
Asia
Brazil
Canada
Decision Support Techniques
Erythrocyte Transfusion
Europe
Female
Humans
Incidence
Intracranial Hemorrhages
Male
Middle Aged
Patient Discharge
Patient Readmission
Percutaneous Coronary Intervention
Platelet Aggregation Inhibitors
Prasugrel Hydrochloride
Predictive Value of Tests
Registries
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome