- 作者：Albert Ariza-Sol茅 ; Guillermo S谩nchez-Elvira ; Jos茅 C. S谩nchez-Salado ; Victoria Lorente-Tordera ; Joel Salazar-Mendiguch铆a ; Remedios S谩nchez-Prieto ; Rafael Romaguera-Torres ; Jos茅 L. Ferreiro-Guti茅rrez ; Joan A. G贸mez-Hospital ; Angel Cequier-Fillat
- 关键词：ACS ; Acute coronary syndromes ; CBRS ; CRUSADE) bleeding risk score ; NSTEMI ; Non-ST segment elevation myocardial infarction ; STEMI ; ST segment elevation myocardial infarction ; PCI ; Percutaneous coronary intervention
- 刊名：Thrombosis Research
- 出版年：December, 2013
- 年：2013
- 卷：132
- 期：6
- 页码：652-658
- 全文大小：584 K
Introduction
The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).Materials and Methods
We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC).
Results
We included 1064 patients (mean age 63 years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n = 621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344 days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001).
Conclusions
Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.