Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score

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

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P4650Ischemic and bleeding risk prediction in Acute Coronary Syndrome - The search for an almighty risk score

European Heart Journal ◽

10.1093/eurheartj/ehx504.p4650 ◽

2017 ◽

Vol 38 (suppl_1) ◽

Author(s):

M. Coutinho Cruz ◽

A.T. Timoteo ◽

R. Ilhao Moreira ◽

S. Aguiar Rosa ◽

L. Ferreira ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Prediction ◽

Risk Score ◽

Bleeding Risk ◽

Coronary Syndrome

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Clinical impact of CREDO-kyoto risk score on in-hospital bleeding in patients with acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehab724.1412 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

Y Minematsu ◽

M Natsuaki ◽

G Yoshioka ◽

K Shinzato ◽

Y Nishimura ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Risk Score ◽

Major Bleeding ◽

Bleeding Risk ◽

Risk Groups ◽

University Hospital ◽

Severe Bleeding ◽

Bleeding Events ◽

Coronary Syndrome

Abstract Background/Introduction CREDO-Kyoto bleeding risk score was developed to predict the post-discharge bleeding events in patients with percutaneous coronary intervention. However, there were limited reports of the effectiveness of this score to predict the in-hospital bleeding events in patients with acute coronary syndrome (ACS). Methods We evaluated 562 consecutive ACS patients in Saga university hospital between 2014 and 2019. Primary outcome was major bleeding during hospitalization. Major bleeding was defined as the GUSTO moderate/severe bleeding. Patients were classified into three groups according to the CREDO-Kyoto bleeding risk score (low, intermediate and high). Results Major bleeding events occurred in 12.1% of all patients during hospitalization. Patients in the high risk group (n=22) had significantly higher incidence of major bleeding than those in the intermediate (n=113) and the low risk groups (n=427) (22.7%, 18.6%, versus 9.8%, respectively, p=0.018, see figure). Multivariate analysis showed that intermediate and high risk groups were independent predictors for the in-hospital major bleeding. Conclusions CREDO-Kyoto risk score successfully identified high risk ACS patients for the major bleeding during hospitalization. FUNDunding Acknowledgement Type of funding sources: None. Results

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Development and validation of a cardiovascular risk score for patients in the community after acute coronary syndrome

Heart ◽

10.1136/heartjnl-2019-315809 ◽

2019 ◽

Vol 106 (7) ◽

pp. 506-511 ◽

Cited By ~ 1

Author(s):

Katrina K Poppe ◽

Rob N Doughty ◽

Susan Wells ◽

Billy Wu ◽

Nikki J Earle ◽

...

Keyword(s):

Risk Management ◽

Acute Coronary Syndrome ◽

Risk Score ◽

Cox Model ◽

External Validation ◽

Laboratory Data ◽

Cvd Risk ◽

Coronary Syndrome ◽

C Statistic ◽

National Mortality

ObjectiveFollowing acute coronary syndrome (ACS), patients are managed long-term in the community, yet few tools are available to guide patient-clinician communication about risk management in that setting. We developed a score for predicting cardiovascular disease (CVD) risk among patients managed in the community after ACS.MethodsAdults aged 30–79 years with prior ACS were identified from a New Zealand primary care CVD risk management database (PREDICT) with linkage to national mortality, hospitalisation, pharmaceutical dispensing and regional laboratory data. A Cox model incorporating clinically relevant factors was developed to estimate the time to a subsequent fatal or non-fatal CVD event and transformed into a 5-year risk score. External validation was performed in patients (Coronary Disease Cohort Study) assessed 4 months post-ACS.ResultsThe PREDICT-ACS cohort included 13 703 patients with prior hospitalisation for ACS (median 1.9 years prior), 69% men, 58% European, median age 63 years, who experienced 3142 CVD events in the subsequent 5 years. Median estimated 5 year CVD risk was 24% (IQR 17%–35%). The validation cohort consisted of 2014 patients, 72% men, 92% European, median age 67 years, with 712 CVD events in the subsequent 5 years. Median estimated 5-year risk was 33% (IQR 24%–51%). The risk score was well calibrated in the derivation and validation cohorts, and Harrell’s c-statistic was 0.69 and 0.68, respectively.ConclusionsThe PREDICT-ACS risk score uses data routinely available in community care to predict the risk of recurrent clinical events. It was derived and validated in real-world contemporary populations and can inform management decisions with patients living in the community after experiencing an ACS.

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Evaluating the Performance of the CRUSADE Bleeding Risk Score for Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Heart Lung and Circulation ◽

10.1016/j.hlc.2012.05.386 ◽

2012 ◽

Vol 21 ◽

pp. S154

Author(s):

D. Stub ◽

N. Andrianopoulos ◽

A. Brennan ◽

P. Loane ◽

R. Sharma ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Risk Score ◽

Bleeding Risk ◽

Coronary Intervention ◽

Coronary Syndrome ◽

Percutaneous Coronary

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The Bleeding Risk Score as a Mortality Predictor in Patients with Acute Coronary Syndrome

Arquivos Brasileiros de Cardiologia ◽

10.5935/abc.20130223 ◽

2013 ◽

Cited By ~ 1

Author(s):

José Carlos Nicolau ◽

Humberto Graner Moreira ◽

Luciano Moreira Baracioli ◽

Carlos Vicente Serrano Junior ◽

Felipe Galego Lima ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Score ◽

Bleeding Risk ◽

Coronary Syndrome

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PREDICTION OF BLEEDING ADMISSION IN THE FIRST YEAR AFTER ACUTE CORONARY SYNDROME AND PROGNOSTIC IMPACT: THE CARDIOCHUS BLEEDING RISK SCORE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60032-2 ◽

2014 ◽

Vol 63 (12) ◽

pp. A32 ◽

Cited By ~ 1

Author(s):

Sergio Raposeiras Roubin ◽

Emad HA Abu-Assi ◽

Belen Alvarez Alvarez ◽

Maria Cristina Gonzalez Cambeiro ◽

Pilar Mazon-Ramos ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Score ◽

Bleeding Risk ◽

First Year ◽

Prognostic Impact ◽

Coronary Syndrome

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Validation of the Grace Risk Score to Predict In-Hospital and 6-Month Post-Discharge Mortality in Patients with Acute Coronary Syndrome

International Journal of Cardiovascular Sciences ◽

10.36660/ijcs.20210019 ◽

2021 ◽

Author(s):

Vítor Boniatti Neves ◽

Raquel Melchior Roman ◽

Tiago Vendruscolo ◽

Gilberto Heineck ◽

Carlos Alberto Santos de Mattos ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Risk Score ◽

Post Discharge ◽

Coronary Syndrome ◽

Grace Risk Score

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Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617719638 ◽

2017 ◽

Vol 8 (8) ◽

pp. 727-737 ◽

Cited By ~ 13

Author(s):

Stuart J Pocock ◽

Yong Huo ◽

Frans Van de Werf ◽

Simon Newsome ◽

Chee Tang Chin ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Confidence Interval ◽

Risk Score ◽

Mortality Risk ◽

Post Discharge ◽

Coronary Syndrome ◽

Predictive Variables ◽

C Statistic ◽

Risk Scoring

Background: Long-term risk of post-discharge mortality associated with acute coronary syndrome remains a concern. The development of a model to reliably estimate two-year mortality risk from hospital discharge post-acute coronary syndrome will help guide treatment strategies. Methods: EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (EPICOR Asia, NCT01361386) are prospective observational studies of 23,489 patients hospitalized for an acute coronary syndrome event, who survived to discharge and were then followed up for two years. Patients were enrolled from 28 countries across Europe, Latin America and Asia. Risk scoring for two-year all-cause mortality risk was developed using identified predictive variables and forward stepwise Cox regression. Goodness-of-fit and discriminatory power was estimated. Results: Within two years of discharge 5.5% of patients died. We identified 17 independent mortality predictors: age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class. Geographic variation in mortality risk was seen following adjustment for other predictive variables. The developed risk-scoring system provided excellent discrimination ( c-statistic=0.80, 95% confidence interval=0.79–0.82) with a steep gradient in two-year mortality risk: >25% (top decile) vs. ~1% (bottom quintile). A simplified risk model with 11 predictors gave only slightly weaker discrimination ( c-statistic=0.79, 95% confidence interval =0.78–0.81). Conclusions: This risk score for two-year post-discharge mortality in acute coronary syndrome patients ( www.acsrisk.org ) can facilitate identification of high-risk patients and help guide tailored secondary prevention measures.

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