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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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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Predicting bleeding and intra-hospital mortality in acute coronary syndromes: A multicentre comparison study between two risk scores
Session:
Posters 5 - Écran 1 - Doença Coronária
Speaker:
Diogo Brás
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:
Diogo Brás; Rui Azevedo Guerreiro; Mafalda Carrington; Antonio; Kisa Hyde Congo; João Carvalho; Ana Rita Santos; Bruno Cordeiro Piçarra; José Eduardo Aguiar; Registo Nacional de SCA
Abstract
<p>BACKGROUND</p> <p>Recent advances in antithrombotic drugs have resulted in significant improvements in the treatment of patients with Acute Coronary Syndrome (ACS). However, these advances were also accompanied by an increase in the incidence of haemorrhagic complications and sometimes, intra-hospital mortality.</p> <p> </p> <p>PURPOSE</p> <p>The authors sought to compare two risk scores carried out at patient admission in ACS, CRUSADE and "intra-hospital bleeding and mortality in ACS score" (IBMACS), and study which one performed better regarding the outcomes: intra-hospital haemorrhagic complication (transfusion or major bleeding event) (IHC) and intra-hospital mortality (IM).</p> <p> </p> <p>METHODS</p> <p>This retrospective and multicentre study is composed of a sample of 13.182 patients admitted with ACS, collected from a national registry of ACS.</p> <p>The IBMACS score was defined by: age > 75 years: 2 points; past bleeding history: 1 point; admission serum creatinine >1.5mg/dL: 1 point; admission haemoglobin < 10g/dL: 1 point.</p> <p>The IBMACS and CRUSADE scores were calculated for each patient. We have also collected data about cardiovascular risk factors, past medical history, antithrombotic drugs and catheterization vascular access.</p> <p>A multivariate analysis and ROC curve was performed for each score regarding each of the two outcomes: IHC and IM. Then, the ROC curves were compared between CRUSADE and IBMACS score and both outcomes.</p> <p> </p> <p>RESULTS</p> <p>The sample mean age was 65 ± 13 years old, with 74% of males. Past history of bleeding events were present in 1.8%, past ACS in 19.9%, past stroke in 7.5%, hypertension in 69.7% (systolic BP 139 ± 29 mmHg), diabetes in 29.9%, admission serum creatinine of 1.1 ± 0.9 mg/dL, admission haemoglobin of 13.8 ± 1.9 g/dL and admission signs of heart failure 14.5%. The mean IBMACS score was 1.3 ± 0.6, and the mean CRUSADE score was 26.7 ± 16.6.</p> <p>In the ROC curve analysis, regarding IHC, the AUC was 0.719 (sensitivity (SE) 69.2%, specificity (SP) 67.9%) for IBMACS and 0.776 (SE 68.8%, SP 75.3%) for CRUSADE (p<0.001). In relation to IM, the AUC was 0.723 (SE 71.3%, SP 68.2%) for IBMACS and 0.840 (SE 82.5%, SP 72.8%) for CRUSADE (p<0.001).</p> <p> </p> <p>CONCLUSIONS</p> <p>In this study, we intended to compare a previously assessed score (IBMACS) with the extensively validated CRUSADE score, in terms of intra-hospital ACS complications and mortality.</p> <p>We acknowledge the big predicting power of the CRUSADE score regarding both outcomes. However, the difference between scores was attenuated in the IHC, with a small difference between the two AUC curves of 0.057. The IBMACS score also had a slightly bigger SE in predicting IHC. It is also true that the CRUSADE score needs input from 8 variables and may require a dedicated calculator. The IBMACS score is composed of 4 easily assessed binary variables, resulting in a faster manual calculation.</p> <p>In summary, the IBMACS score may have a role in a faster, easier prediction IHC in the admission of ACS patients, without a loss of SE.</p>
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