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Hemorrhagic risk scores in Acute Coronary Syndromes: prediction of in-hospital bleeding complications
Session:
Painel 6 - Doença Coronária 13
Speaker:
Joana Laranjeira Correia
Congress:
CPC 2020
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:
Joana Laranjeira Correia; João Miguel Santos; Inês Pires; Luísa Gonçalves; Hugo Da Silva Antunes; António Costa; José Costa Cabral
Abstract
<p><strong>Background: </strong>Bleeding risk stratification in acute coronary syndrome (ACS) is extremely importante, given that its occurrence is associated with a worse prognosis. The identification of different bleeding risk assessment tools may help the clinician to optimize treatment options and improve important outcomes. Different hemorragic risk scores are currently used in patients with ACS (CRUSADE, MEHRAN, ACTION). Other risk scores (ATRIA, HEMORRHAGES) are currently used in patients with atrial fibrillation, however their applicability in patients with ACS has not been evaluated. The objective of this study is to apply the aforementioned risk scores in a group of patients admitted with ACS.</p> <p><strong>Methods</strong>: A retrospective study of patients admitted with ACS in the cardiology service was performed. Hemorrhagic events were defined as hemorrhagic stroke, major bleeding or need for blood transfusion. The different risk scores were calculated for all patients and ROC curves were determined to ascertain the predictive capacity for in-hospital bleeding complications.</p> <p><strong>Results</strong>: 840 patients were included; 72.6% were male and mean age was 68±14 years old. There were 42 hemorrhagic events (5%). The mean values obtained for each score in patients with vs without bleeding complications were: 35.4±9 vs 28.8±8 for ACTION , 40±15,3 vs 31,4±16 for CRUSADE, 21.5±8,2 vs 18.4±8,5 for MEHRAN, 3.3±2.6 vs 2.3±2.2 for ATRIA, 2.8±1.8 vs 1.9±1.5 for HEMORRHAGES. For each risk score, ROC curves were obtained with the following c-statistic: HEMORRHAGES score - 0,657 (p=0.001); ATRIA score - 0,652 (p=0.001); MEHRAN score - 0,658 (p=0.001); CRUSADE score - 0,689 (p<0.001); ACTION score - 0,712 (p<0.001). For a ACTION score > 30.5 we had a sensibility of 71% and specificity of 65%. For an ACTION <30.5 and >30.5 the in-hospital mortality was, respectively, 0.95% and 13.42%. For ACTION score, a ROC curve was obtained to ascertain the predictive capacity for intra-hospital mortality, presenting the following c-statistic value: 0.860 (p <.001).</p> <p><strong>Conclusion</strong>: In this population, only the ACTION score presented an acceptable predictive power for bleeding complications. Although ATRIA and HEMORRHAGES are simpler these scores have a lower predictive value comparing with the scores that are currently used. In addition, the ACTION score has a good predictive power for in-hospital mortality, demonstrating that bleeding complications are associated with poor prognosis and increased mortality.</p>
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