HAS-BLED score predicts risk of in-hospital major bleeding in patients with acute non-ST segment elevation myocardial infarction.
BACKGROUND
The role of the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs or alcohol use (HAS-BLED) score in the prediction of in-hospital bleeding in non-ST segment elevation myocardial infarction (NSTEMI) patients receiving dual anti-platelet therapy plus heparin was unknown. In this study, we compared the HAS-BLED score with the Can Rapid Risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage strategY and the Harmonizing Outcomes with RevascularIZatiON and Stents in acute myocardial infarction (ACUITY-HORIZONS) bleeding risk scores for in-hospital major bleeding risk stratification in NSTEMI patients.


METHODS
A real world population of 617 NSTEMI patients receiving dual anti-platelet plus heparin as initial therapy were enrolled. CRUSADE, ACUITY-HORIZONS and HAS-BLED risk scores were calculated for each patient.


RESULTS
This cohort had a 6.5% incidence of in-hospital major bleeding. For the prediction of in-hospital major bleeding, the discriminations between CRUSADE, ACUITY-HORIZONS and HAS-BLED were good (C-statistic 0.81, 0.82 and 0.80, respectively). There was no significant difference between these three risk scores (HAS-BLED vs. CRUSADE: z=-0.08, p=0.27; HAS-BLED vs. ACUITY-HORIZONS: z=-0.06, p=0.26; CRUSADE vs. ACUITY-HORIZONS: z=-0.15, p=0.28).


CONCLUSIONS
The CRUSADE, ACUITY-HORIZONS and HAS-BLED scores were useful tools for risk stratification of in-hospital major bleeding in NSTEMI patients. The HAS-BLED score had a simpler calculation and a similar accuracy for risk assessment as the other two scores evaluated.
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Ming-Jer
MJ
Hsieh
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Chun-Chieh
CC
Wang
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Chun-Chi
CC
Chen
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Chun-Li
CL
Wang
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan.
Lung-Sheng
LS
Wu
Department of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan. Electronic address: a12390@cgmh.org.tw.
I-Chang
IC
Hsieh
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology*; D018570:Risk Assessment
ACUITY-HORIZONS; CRUSADE; HAS-BLED; Major bleeding; NSTEMI