Predictors of major bleeding following an acute coronary event: insights from a national study of 5,116 consecutive patients in clinical practice

Autor: Matthew Shaw, M Meah, A Elamin, L Mullen, S Aggarwal, Adeel Shahzad, Aleem Khand
Rok vydání: 2020
Předmět:
Zdroj: European Heart Journal. 41
ISSN: 1522-9645
0195-668X
DOI: 10.1093/ehjci/ehaa946.1653
Popis: Background Major bleeding after acute coronary syndrome (ACS) predicts a poor outcome. Although predictors of major bleeding following ACS have been validated, these have been mostly in clinical trial populations and few contemporary analyses have been undertaken in clinical practise Methods Major bleeding was assessed in a national study of ACS and antiplatelet choice. A total of 5116 consecutive patients [Clopidogrel (n 2,491, 2011–13) and Ticagrelor (n 2,625, 2013–16)] were enrolled in 5 UK hospitals. Clinical outcomes were identified from a national coding database (n=59.5 million) with bleeding events tracked to 11 health care facilities. Bleed severity was independently adjudicated by 2 consultant cardiologists, blinded to antiplatelet, sequence and year. Bleeding events were categorised using BARC 3–5 and PLATO criteria. A logistic regression analysis was used to define independent predictors of bleeding. Results The median age was 68 (IQR57–78, 30.5%>75), 34% were female. 39% underwent PCI and 13% coronary artery bypass surgery. Clinical outcome data was 100% complete. 1-year mortality was 12.9%. Of 1193 icd10 codes for bleeding or anaemia 165 (3.2%) and 193 (3.8%) patients were adjudicated to have suffered a BARC 3–5 and PLATO major bleeding respectively. Independent predictors common between PLATO major and BARC 3–5 bleeding, in the year following ACS, were CRUSADE score >40 (OR 1.63, CI 1.1–2.4, p=0.008) moderate left ventricular systolic dysfunction (OR, 1.65, CI: 1.2–2.4, p=0.006), age (OR per year increase in age 1.03, CI 1.02–1.05, p Conclusion In a broad real-world population of ACS, CRUSADE score >40, incorporating simple clinical and laboratory criteria, remained an independent predictor of major bleeding using 2 internationally recognised bleed criteria Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Liverpool university hospitals; North-West Educational Cardiac Group
Databáze: OpenAIRE
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