The bleeding risk score as a mortality predictor in patients with acute coronary syndrome.
BACKGROUND
It is well known that the occurrence of bleeding increases in-hospital mortality in patients with acute coronary syndromes (ACS), and there is a good correlation between bleeding risk scores and bleeding incidence. However, the role of bleeding risk score as mortality predictor is poorly studied.


OBJECTIVE
The main purpose of this paper was to analyze the role of bleeding risk score as in-hospital mortality predictor in a cohort of patients with ACS treated in a single cardiology tertiary center.


METHODS
Out of 1655 patients with ACS (547 with ST-elevation ACS and 1118 with non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score prospectively in 249 patients and retrospectively in the remaining 1416. Mortality information and hemorrhagic complications were also obtained.


RESULTS
Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The correlation between bleeding and mortality was highly significant (p < 0.001, OR = 5.296), as well as the correlation between bleeding score and in-hospital bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p < 0.001). The adjusted OR and area under the ROC curve for the population with ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p < 0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p < 0.001) and 0.769 ± 0.036 (p < 0.001).


CONCLUSIONS
Bleeding risk score is a very useful and highly reliable predictor of in-hospital mortality in a wide range of patients with acute coronary syndromes, especially in those with unstable angina or non-ST-elevation acute myocardial infarction.
José Carlos
JC
Nicolau
Humberto Graner
HG
Moreira
Luciano Moreira
LM
Baracioli
Carlos Vicente
CV
Serrano
Felipe Galego
FG
Lima
Marcelo
M
Franken
Roberto Rocha
RR
Giraldez
Fernando
F
Ganem
Roberto
R
Kalil Filho
José Antônio Franchini
JA
Ramires
Roxana
R
Mehran
D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality*; D000328:Adult; D000368:Aged; D017130:Angioplasty; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006470:Hemorrhage / Q000150:complications / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment
D005343:Fibrinolytic Agents