title: STEMI patients--the more you bleed, the more you die: a comparison between classifications.
abstract: BACKGROUND
  In patients with acute coronary syndromes, an increase in hemorrhagic complications has been observed, and bleeding is now the most frequent noncardiac complication in these patients. Clinical trials and registries have used different scales to classify the severity of bleeding; so far, none of them has been developed for ST-segment elevation myocardial infarction (STEMI) patients in the era of primary percutaneous coronary intervention.
  
  
  METHODS
  We analyzed data from our Intensive Cardiac Care Florence STEMI Registry, comprising 991 STEMI patients consecutively admitted to our intensive cardiac care unit after mechanical revascularization, to assess the clinical impact of both Thrombolysis In Myocardial Infarction (TIMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) classifications in identifying patients with major bleeding at higher risk for in-hospital mortality.
  
  
  RESULTS
  Major bleeding events occurred in 8.9% of patients (88/991) in the TIMI classification and in 17.2% of patients (170/991) in the ACUITY classification. Among patients with major bleeding classified according to ACUITY, 82 patients did not meet the TIMI criteria for major bleeding. These patients represent the so-called gray zone, where no transfusion was performed and only 1 patient died.
  
  
  CONCLUSIONS
  In STEMI patients who undergo primary percutaneous coronary intervention and receive dual antiplatelet therapy, TIMI is more capable than ACUITY in identifying patients with major bleeding at higher risk for early mortality. The presence of renal failure represents an independent predictor for major bleeding.
authors.affiliation: Intensive Cardiac Care Unit, Heart and Vessel Department, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, Florence, Italy. seravalente@hotmail.com
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Marco
authors.initials: M
authors.lastname: Chiostri
authors.forename: Lusinda
authors.initials: L
authors.lastname: Osmanagaj
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006470:Hemorrhage / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors