Bleeding Risk Scores and Scales of Frailty for the Prediction of Haemorrhagic Events in Older Adults with Acute Coronary Syndrome: Insights from the FRASER study

2019 ◽  
Vol 33 (5) ◽  
pp. 523-532 ◽  
Author(s):  
Rita Pavasini ◽  
Elisa Maietti ◽  
Elisabetta Tonet ◽  
Giulia Bugani ◽  
Matteo Tebaldi ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Coronary Syndrome ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndrome

Association Between Ischemic and Bleeding Risk Scores and the Use of New P2Y 12 Inhibitors in Patients With Acute Coronary Syndrome

2018 ◽  
Vol 71 (7) ◽  
pp. 538-544
Author(s):  
Pedro J. Flores-Blanco ◽  
Francisco Cambronero-Sánchez ◽  
Sergio Raposeiras-Roubin ◽  
Emad Abu-Assi ◽  
Gunnar Leithold ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndrome

scholarly journals Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome

2012 ◽  
Vol 1 (3) ◽  
pp. 222-231 ◽  
Author(s):  
Emad Abu-Assi ◽  
Sergio Raposeiras-Roubin ◽  
Pamela Lear ◽  
Pilar Cabanas-Grandío ◽  
Mar Girondo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Predictive Validity ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndrome

External validation of PRECISE-DAPT score and PARIS bleeding risk score in a real-world cohort of patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D.R.P.P Chan Pin Yin ◽  
D.M.F Claassens ◽  
F.P Van Baal ◽  
G.J Vos ◽  
J Peper ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Score ◽  
External Validation ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Severe Bleeding ◽  
Coronary Syndrome ◽  
Kaplan Meier ◽  
One Year

Abstract Background In patients with acute coronary syndrome (ACS) shortened duration of dual antiplatelet therapy (DAPT) should be considered in those at high risk of bleeding. Risk scores may be used to assess the bleeding risk, but their predictive value remains unclear. Purpose To externally validate and compare the PRECISE-DAPT and the PARIS bleeding risk scores in patients with ACS. Methods From January 2015 to June 2018, all patients admitted with ACS were consecutively included in a single center, observational, prospective registry with follow-up of at least one year. In all patients, the PRECISE-DAPT and the PARIS risk-score were retrospectively assessed. Primary endpoint was moderate or severe bleeding defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding within one year after ACS. Kaplan-Meier curves showed the probabilty of bleeding during follow-up as assessed by both scores. Score discrimination using c-statistic were calculated and calibration curves were visually assessed. Results 2,729 patients were included for analysis. 93.6% were discharged with ≥2 antithrombotic drugs. At one year follow-up, the event rate of moderate or severe bleeding was 5.5%. High bleeding risk as stratified by both risk scores was associated with higher bleeding rates. Discriminative values for BARC 3 or 5 bleeding at one year were 0.67 [95% CI 0.61–0.72] for the PRECISE-DAPT score and 0.62 [95% CI 0.57–0.68] for the PARIS bleeding score (p=0.31). Conclusion The PRECISE-DAPT and the PARIS bleeding scores both showed adequate discriminative performances in predicting moderate or severe bleeding in this study. Kaplan-meier and ROC-curves Funding Acknowledgement Type of funding source: None

scholarly journals The Assessment of Scales of Frailty and Physical Performance Improves Prediction of Major Adverse Cardiac Events in Older Adults with Acute Coronary Syndrome

2019 ◽  
Vol 75 (6) ◽  
pp. 1113-1119 ◽  
Author(s):  
Gianluca Campo ◽  
Elisa Maietti ◽  
Elisabetta Tonet ◽  
Simone Biscaglia ◽  
Albert Ariza-Solè ◽  
...  
Keyword(s):  
Older Adults ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Hospital Discharge ◽  
Physical Performance ◽  
Clinical Decision Making ◽  
Risk Scores ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Baseline Characteristics

Abstract Background The number of older adults admitted to hospital for acute coronary syndrome (ACS) has increased worldwide. The aim of this study was to determine which scale of frailty or physical performance provides incremental improvements in risk stratification of older adults after ACS. Methods A prospective cohort of 402 older (≥70 years) ACS patients were enrolled. Data about baseline characteristics, Global Registry of Acute Coronary Events (GRACE), and Thrombolysis in Myocardial Infarction (TIMI) risk scores were collected. Before hospital discharge, seven scales of frailty and physical performance were measured. The 1-year occurrence of adverse events (cardiac death, reinfarction, and cerebrovascular accident [MACCE] and all-cause mortality) was recorded. Results Out of the 402 patients, 43 (10.5%) had a MACCE and 35 (8.7%) died. Following adjustment for confounding factors, scales of frailty and physical performance were associated with adverse events. Among the scales, the addition of short physical performance battery (SPPB) produced the highest incremental value over the initial model generated by baseline characteristics both for MACCE (ΔC-statistic 0.043, p = .04; integrated discrimination improvement (IDI) 0.054, p = .001; net reclassification improvement (NRI) 0.752, p < .001) and all-cause mortality (ΔC-statistic 0.063, p = .02; IDI 0.061, p < .001; NRI 1.022, p < .001). The addition of SPPB scale on top of GRACE or TIMI risk scores led to a considerable improvement in the prediction of MACCE and all-cause mortality (about 15% and 20%, respectively). Conclusions The assessment of the physical performance with SPPB scale before hospital discharge increases the ability to predict adverse events in older ACS patients and may be useful in the clinical decision-making process. Clinical trial registration www.clinicaltrials.gov NCT02386124.

scholarly journals Risk Assessment Using Risk Scores in Patients with Acute Coronary Syndrome

2020 ◽  
Vol 9 (9) ◽  
pp. 3039 ◽  
Author(s):  
Dean Chan Pin Yin ◽  
Jaouad Azzahhafi ◽  
Stefan James
Keyword(s):  
Risk Assessment ◽  
Acute Coronary Syndrome ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Treatment Decision ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Cardiac Events ◽  
Post Discharge ◽  
Coronary Syndrome

Risk scores are widely used in patients with acute coronary syndrome (ACS) prior to treatment decision-making at different points in time. At initial hospital presentation, risk scores are used to assess the risk for developing major adverse cardiac events (MACE) and can guide clinicians in either discharging the patients at low risk or swiftly admitting and treating the patients at high risk for MACE. During hospital admission, risk assessment is performed to estimate mortality, residual ischemic and bleeding risk to guide further in-hospital management (e.g., timing of coronary angiography) and post-discharge management (e.g., duration of dual antiplatelet therapy). In the months and years following ACS, long term risk can also be assessed to evaluate current treatment strategies (e.g., intensify or reduce pharmaceutical treatment options). As multiple risk scores have been developed over the last decades, this review summarizes the most relevant risk scores used in ACS patients.

scholarly journals Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

2021 ◽  
Vol 10 (3) ◽  
pp. 444
Author(s):  
Juan Sanchis ◽  
Clara Bonanad ◽  
Sergio García-Blas ◽  
Vicent Ruiz ◽  
Agustín Fernández-Cisnal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adults ◽  
Acute Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Prognostic Value ◽  
Adult Survivors ◽  
Prognostic Information ◽  
Coronary Syndrome

Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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