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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Identification of a major bleeding predictive score in acute coronary syndrome
Session:
Posters 3 - Écran 2 - Doença Coronária
Speaker:
Raquel Menezes Fernandes
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Raquel Menezes Fernandes; Teresa Faria Da Mota; João De Sousa Bispo; Pedro Oliveira De Azevedo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> In Acute coronary syndrome (ACS), major bleeding (MB) is a serious complication and is associated with a worse prognosis. This study pretends to determine a predictive score of MB in patients with ACS.</p> <p><strong>Methods: </strong>We conducted a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1<sup>st</sup> October 2010 to 1<sup>st</sup> October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of MB were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. For statistical analysis, SPSS 24.0 was used.</p> <p><strong>Results:</strong> A total of 4458 patients were admitted with ACS, and 86 (1,9%) had MB during the hospitalization. In this subgroup, 81,4% were over 65 years of age, 74,9% were males, 61,6% had acute myocardial infarction with ST-segment elevation (STEMI), 15,1% had hemoglobin (Hb) <10 g/dL and 36% were medicated with aspirin on an outpatient basis. The in-hospital mortality rate was 17,4%. Age >65 years (p=0,016), STEMI (p=0,019), hemoglobin <10 g/dL (p=0,027), and history of medication with aspirin (p<0,001) were independent predictors of MB. A predictive score of MB in patients with ACS was determined with the formula: - 1,238 + 1,166x(age>65) + 0,959x(STEMI) + 3,7x(Hb<10) + 0,504x(history of taking aspirin). A cutoff of 0,51 was obtained with 60,5% sensitivity, 79,6% specificity and 79,2% discriminative power.</p> <p><strong>Conclusion:</strong> In this population of patients admitted with ACS, 1,9% presented MB. A predictive score of MB with a good discriminative power was determined, and included age >65 years, STEMI, hemoglobin <10 g/dL and previous medication with aspirin. By considering clinical variables, this score can be used at a very early stage of hospital admission, in order to stratify the hemorrhagic risk of each patient. It still needs validation to allow its application in clinical practice.</p>
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