title: Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE).
abstract: OBJECTIVE
  There have been no large observational studies attempting to identify predictors of major bleeding in patients with acute coronary syndromes (ACS), particularly from a multinational perspective. The objective of our study was thus to develop a prediction rule for the identification of patients with ACS at higher risk of major bleeding.
  
  
  RESULTS
  Data from 24045 patients from the Global Registry of Acute Coronary Events (GRACE) were analysed. Factors associated with major bleeding were identified using logistic regression analysis. Predictive models were developed for the overall patient population and for subgroups of patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The overall incidence of major bleeding was 3.9% (4.8% in patients with STEMI, 4.7% in patients with NSTEMI and 2.3% in patients with unstable angina). Advanced age, female sex, history of bleeding, and renal insufficiency were independently associated with a higher risk of bleeding (P<0.01). The association remained after adjustment for hospital therapies and performance of invasive procedures. After adjustment for a variety of potential confounders, major bleeding was significantly associated with an increased risk of hospital death (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.28).
  
  
  CONCLUSIONS
  In routine clinical practice, major bleeding is a relatively frequent non-cardiac complication of contemporary therapy for ACS and it is associated with a poor hospital prognosis. Simple baseline demographic and clinical characteristics identify patients at increased risk of major bleeding.
authors.affiliation: University of Michigan Health System, Ann Arbor, MI 48109, USA. moscucci@umich.edu
authors.forename: M
authors.initials: M
authors.lastname: Moscucci
authors.forename: K A A
authors.initials: KA
authors.lastname: Fox
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.forename: W
authors.initials: W
authors.lastname: Klein
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: G
authors.initials: G
authors.lastname: Montalescot
authors.forename: K
authors.initials: K
authors.lastname: White
authors.forename: R J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D014943:Global Health; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors