title: Efficacy of bleeding risk scores in elderly patients with acute coronary syndromes.
abstract: OBJECTIVE
  The incidence of acute coronary syndromes is high in the elderly population. Bleeding is associated with a poorer prognosis in this clinical setting. The available bleeding risk scores have not been validated specifically in the elderly. Our aim was to assess predictive ability of the most important bleeding risk scores in patients with acute coronary syndrome aged ≥ 75 years.
  
  
  METHODS
  We prospectively included consecutive acute coronary syndromes patients. Baseline characteristics, laboratory findings, and hemodynamic data were collected. In-hospital bleeding was defined according to CRUSADE, Mehran, ACTION, and BARC definitions. CRUSADE, Mehran, and ACTION bleeding risk scores were calculated for each patient. The ability of these scores to predict major bleeding was assessed by binary logistic regression, receiver operating characteristic curves, and area under the curves.
  
  
  RESULTS
  We included 2036 patients, with mean age of 62.1 years; 369 patients (18.1%) were ≥ 75 years. Older patients had higher bleeding risk (CRUSADE, 42 vs 22; Mehran, 25 vs 15; ACTION, 36 vs 28; P<.001) and a slightly higher incidence of major bleeding events (CRUSADE bleeding, 5.1% vs 3.8%; P=.250). The predictive ability of these 3 scores was lower in the elderly (area under the curve, CRUSADE: 0.63 in older patients, 0.81 in young patients; P=.027; Mehran: 0.67 in older patients, 0.73 in younger patients; P=.340;
  
  
  METHODS
  0.58 in older patients, 0.75 in younger patients; P=.041).
  
  
  CONCLUSIONS
  Current bleeding risk scores showed poorer predictive performance in elderly patients with acute coronary syndromes than in younger patients.
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: aariza@bellvitgehospital.cat.
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.affiliation: Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lorente
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: José C
authors.initials: JC
authors.lastname: Sánchez-Salado
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sánchez-Elvira
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Sánchez-Prieto
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Vila
authors.affiliation: Unidad Coronaria, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Moliner
authors.affiliation: Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D017677:Age Distribution; D000368:Aged; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Acute coronary syndromes; Anciano; Bleeding risk; Elderly; Riesgo hemorrágico; Síndrome coronario agudo