scholarly journals Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

2018 ◽  
Vol 118 (05) ◽  
pp. 929-938 ◽  
Author(s):  
Alberto Garay ◽  
Francesc Formiga ◽  
Sergio Raposeiras-Roubín ◽  
Emad Abu-Assi ◽  
José Sánchez-Salado ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Roc Curves ◽  
Risk Scores ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients. Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine–Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC). Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92–2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001). Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients.

Abstract 3581: Predicting Mortality in Acute Coronary Syndromes; A Comparison of the TIMI and GRACE Risk Scores

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Krishna Aragam ◽  
Umesh Tamhane ◽  
Eva Kline-Rogers ◽  
Jin Li ◽  
Keith A Fox ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Risk Scores ◽  
Admission Diagnosis ◽  
Post Discharge ◽  
Timi Score ◽  
Coronary Syndromes ◽  
Coronary Events ◽  
Grace Score ◽  
Better Than

Background: The Thrombolysis In Myocardial Infarction (TIMI) and the Global Registry of Acute Coronary Events (GRACE) risk scores are widely recognized tools for assessing risk in patients with acute coronary syndromes (ACS). However, their relative predictive abilities remain poorly defined in broad-spectrum ACS populations. Objective: We sought to compare the effectiveness of the GRACE and TIMI risk scores in predicting in-hospital and 6-month post-discharge mortality in unselected patients presenting with ACS. Methods: Data were collected for 3451 patients admitted to the University of Michigan between 1999 and 2005 with an admission diagnosis of ACS. Six month follow-up data were available for 3170 of these patients. GRACE and TIMI scores were calculated for each patient based on previously established criteria. The predictive ability of each score was assessed for two primary outcomes - in-hospital mortality and 6-month mortality - by analyzing the area under each receiver operating characteristic (ROC) curve. Results: The observed mortality was 3.97% (137 deaths) in-hospital and 7.38% (234 deaths) at 6 months among those surviving to hospital discharge. The GRACE score was significantly better than the TIMI score in predicting in hospital and 6-month mortality (p<0.0001 in both cases, Figure ). Conclusion: The GRACE score was significantly better than the TIMI score in predicting in-hospital and 6-month mortality in unselected patients presenting with ACS.

Cardiogenic shock in patients with acute coronary syndromes

2015 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Bleeding and haemostasis disorders

2018 ◽  
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Coronary Syndrome ◽  
Coronary Syndromes

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke).

scholarly journals Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

2016 ◽  
Vol 35 (12) ◽  
pp. 637-644
Author(s):  
Alberto Garay ◽  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Victoria Lorente ◽  
José C. Sánchez-Salado ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Predictive Ability ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndromes

Cardiogenic shock in patients with acute coronary syndromes

2018 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Risk Assessment in Acute Coronary Syndromes

2015 ◽  
Author(s):  
Wael AlJaroudi
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndromes ◽  
The United States ◽  
Left Ventricular ◽  
Risk Scores ◽  
Early Reperfusion ◽  
Coronary Syndrome ◽  
Therapeutic Decisions ◽  
Coronary Syndromes ◽  
St Elevation

Acute coronary syndromes (ACS) include unstable angina pectoris (UAP), non-ST elevation (NSTEMI), and ST elevation acute myocardial infarction (STEMI). Each year, more than 2 million people are hospitalized with ACS in the United States. The initial treatment has evolved over the last few decades from conservative management to early reperfusion therapy. Medical therapy has also significantly changed with the use of newer more potent antiplatelet agents, beta-blockers, angiotensin converting enzyme inhibitors, statins, and anti-anginal drugs, which have resulted in improvement of patient care and survival. There is no role for stress myocardial perfusion imaging (MPI) in the acute presentation; however, rest MPI may be used to identify the culprit lesion and risk stratify patients if injected during chest pain. In stable patients for ACS, submaximal exercise or vasodilator MPI can be performed as early as 48 hours after the event. Several gated MPI-derived variables such as left ventricular (LV) ejection fraction (EF), LV volumes, infarct size, mechanical dyssynchrony, and residual ischemic burden can risk stratify patients and provide prognostic data incremental to validated clinical risk scores such as GRACE (Global Registry of Acute Coronary Syndrome) and TIMI (Thrombolysis in Myocardial Infarction). Patients with depressed LVEF, remodeled LV, and large perfusion defects are at particularly high- risk for subsequent cardiac death or recurrent myocardial infarction. In such setting, MPI plays a pivotal role in the management of patients and guiding therapeutic decisions. The current chapter will review the clinical and MPI predictors of outcomes in patients presenting with ACS according to updated guidelines and a proposed algorithm integrating the role of MPI in guiding therapeutic decisions and management.

Cardiogenic shock in patients with acute coronary syndromes

2017 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Cardiogenic shock in patients with acute coronary syndromes

2016 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Abstract 146: Demographic and Clinical Characteristics Associated with Patient Perceptions of Being Cured Following Hospitalization for Acute Coronary Syndromes: Preliminary Results from TRACE-CORE and TRACE-CARE

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Molly E Waring ◽  
Stephenie C Lemon ◽  
Milena D Anatchkova ◽  
Joel M Gore ◽  
David D McManus ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Acute Coronary Syndromes ◽  
Clinical Characteristics ◽  
Patient Perceptions ◽  
Risk Scores ◽  
Additional Patient ◽  
Post Discharge ◽  
History Of ◽  
Coronary Syndromes ◽  
Heart Condition

Background: Recent decades have seen improvements in treatment for acute coronary syndromes (ACS), reduced mortality, and shortened hospital stays. Limited evidence suggests that some patients may leave the hospital with the perception that they are cured. Objective: To describe demographic and clinical characteristics associated with patient perceptions that their heart condition is cured at one week following hospitalization for ACS. Methods: We analyzed data from 397 patients interviewed during hospitalization for ACS in 2011-2013 as part of the Transitions, Risks, and Actions in Coronary Events: Centers for Outcomes Research and Education (TRACE-CORE), and again at one week post-discharge as part of an ancillary study, TRACE-CARE. At one week, patients were asked “How true or false is this statement for you: My heart condition is cured. Would you say that this is definitely true, mostly true, neutral, mostly false, or definitely false?” We considered patients who responded “definitely true” or “mostly true” to perceive that their heart condition was cured. We calculated 6-month GRACE risk scores using clinical data from medical records. We used multivariable logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with cure perceptions. Results: Participants were 26% (n=105) female and 89% (n=350) non-Hispanic white with mean age 60.7±11.0 years. Sixteen percent (n=63) were hospitalized with unstable angina, 69% (n=266) with NSTEMI, and 14% (n=55) with STEMI; 31% (n=124) had a history of CHD; and the average GRACE risk score was 93.6 (SD: 26.6). Seventy-three percent (n=289) received PCI during hospitalization and 11% (n=43) CABG. Discharge occurred the same or next day for 19% (n=76) and within 2-3 days for 54% (n=214). One week post-discharge, 30% (n=120) perceived their heart condition was cured. In a multivariable model, male sex, unstable angina, no history of CHD, and receipt of CABG were associated with greater odds of perceiving oneself cured (Table). Conclusions: One week post-discharge for ACS, 3 in 10 patients perceived their heart condition was cured. Future research should examine additional patient factors related to cure perceptions, and whether these perceptions influence engagement in recommended secondary prevention strategies.

Sign in / Sign up

Export Citation Format

Share Document