Bellvitge Hospital, Barcelona, Spain.
Hospital Álvaro Cunqueiro, Vigo, Spain.
Thromb Haemost. 2018 May;118(5):929-938. doi: 10.1055/s-0038-1635259. Epub 2018 Apr 3.
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.
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).
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, = 0.001).
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.
据报道，在患有急性冠状动脉综合征（ACS）的老年患者中，推荐风险评分预测院内出血的能力较差。尚无研究评估老年人出院后出血的预测。新的 BleeMACS 评分（伴有急性冠状动脉综合征出院诊断的多中心登记处的出血并发症）旨在预测 ACS 患者出院后的出血。我们旨在评估 BleeMACS 评分在老年患者中的预测能力。
我们评估了年龄≥75 岁的 ACS 患者出院后严重出血的发生率和特征。出血定义为出院后 1 年内发生的任何颅内出血或导致住院和/或输血的出血。我们通过 Fine-Gray 比例风险回归分析根据年龄评估 BleeMACS 评分的预测能力，计算接受者操作特征（ROC）曲线和 ROC 曲线下面积（AUC）。
BleeMACS 登记处包括 15401 名患者，其中 3376/15401（21.9%）年龄≥75 岁。老年患者更常接受氯吡格雷治疗，而较少接受替格瑞洛或普拉格雷治疗。在 3376 名老年患者中，190 名（5.6%）发生出院后出血。老年患者出血的发生率略高（风险比 [HR]，2.31，95%置信区间 [CI]，1.92-2.77）。BleeMACS 评分对老年患者的预测能力略低（AUC，0.652 与 0.691， = 0.001）。
ACS 老年患者出院后出血发生率明显较高。尽管在老年患者中的预测能力较低，但 BleeMACS 评分在这些患者中表现出可接受的性能。
