Ariza-Solé Albert, Salazar-Mendiguchía Joel, Lorente Victòria, Sánchez-Salado José Carlos, Romaguera Rafael, Ferreiro José L, Ñato Marcos, Gómez Hospital Joan A, Cequier Ángel
Bellvitge University Hospital, Barcelona, Spain
Bellvitge University Hospital, Barcelona, Spain.
Eur Heart J Acute Cardiovasc Care. 2015 Jun;4(3):205-10. doi: 10.1177/2048872614538405. Epub 2014 Jun 11.
Previous predictive models of bleeding in acute coronary syndromes (ACSs) used different definitions of bleeding and some of them come from populations lacking important predictors of haemorrhagic complications. Our group previously developed a predictive model of bleeding (PMB), including clinically meaningful variables, providing an optimal predictive ability. We aimed to compare the ability of this PMB with the main available bleeding risk scores for predicting major bleeding according to different definitions in non-selected ACS patients from daily clinical practice.
All ACS patients admitted to the Coronary Care Unit were prospectively included. CRUSADE, Mehran and ACTION bleeding risk scores were calculated for each patient. In-hospital bleeding was recorded using the CRUSADE, TIMI, Mehran, ACTION and BARC definitions. For reasons of clinical relevance, BARC 3 and 5 categories were considered severe BARC bleeding for this study. The predictive ability of the PMB and other bleeding risk scores was assessed by binary logistic regression, ROC curves and areas under the curves (AUCs).
We included 1976 patients. Mean age was 62.1 years. Almost all patients underwent angiography, 65% of them by the radial approach. The incidence of major bleeding was: CRUSADE bleeding 3.9% (77/1976); Mehran bleeding 4.8% (94/1976); ACTION bleeding 3.9% (78/1976); and BARC 3/5 bleeding 2.4% (48/1976). The PMB showed the best ability for predicting major bleeding regardless of the definition used. The differences were specially significant for predicting BARC 3/5 bleeding (AUC: PMB 0.87, Mehran score 0.68, CRUSADE score 0.70 and ACTION score 0.70). The predictive ability of CRUSADE, ACTION and Mehran scores was similar for all the definitions analysed.
Current bleeding risk scores showed a similar predictive ability for major bleeding regardless of the definitions used. Including other clinically meaningful predictors of bleeding into the new PMB significantly improved its predictive ability in the clinical scenario of ACS.
既往急性冠状动脉综合征（ACS）出血预测模型使用了不同的出血定义，其中一些模型来自缺乏出血并发症重要预测因素的人群。我们团队之前开发了一种出血预测模型（PMB），纳入了具有临床意义的变量，具有最佳预测能力。我们旨在比较该PMB与主要现有出血风险评分在日常临床实践中未选择的ACS患者中根据不同定义预测大出血的能力。
前瞻性纳入所有入住冠心病监护病房的ACS患者。计算每位患者的CRUSADE、梅兰和ACTION出血风险评分。使用CRUSADE、TIMI、梅兰、ACTION和BARC定义记录住院期间出血情况。出于临床相关性考虑，本研究将BARC 3和5类定义为严重BARC出血。通过二元逻辑回归、ROC曲线和曲线下面积（AUC）评估PMB和其他出血风险评分的预测能力。
我们纳入了1976例患者。平均年龄为62.1岁。几乎所有患者都接受了血管造影，其中65%采用桡动脉途径。大出血发生率为：CRUSADE出血3.9%（77/1976）；梅兰出血4.8%（94/1976）；ACTION出血3.9%（78/1976）；BARC 3/5出血2.4%（48/1976）。无论使用何种定义，PMB在预测大出血方面表现出最佳能力。在预测BARC 3/5出血方面差异尤为显著（AUC：PMB为0.87，梅兰评分为0.68，CRUSADE评分为0.70，ACTION评分为0.70）。对于所有分析的定义，CRUSADE、ACTION和梅兰评分的预测能力相似。
无论使用何种定义，目前的出血风险评分在预测大出血方面显示出相似的预测能力。在新的PMB中纳入其他具有临床意义的出血预测因素可显著提高其在ACS临床场景中的预测能力。
