title: Accuracy of bleeding scores for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13 759 patients.
abstract: BACKGROUND
  Due to its negative impact on prognosis, a clear assessment of bleeding risk for patients presenting with acute coronary syndrome (ACS) remains crucial. Different risk scores have been proposed and compared, although with inconsistent results.
  
  
  OBJECTIVE
  We performed a meta-analysis to evaluate the accuracy of different bleeding risk scores for ACS patients.
  
  
  METHODS
  All studies externally validating risk scores for bleeding for patients presenting with ACS were included in the present review. Accuracy of risk scores for external validation cohorts to predict major bleeding in patients with ACS was the primary end point. Sensitivity analysis was performed according to clinical presentation (ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI)).
  
  
  RESULTS
  Nine studies and 13 759 patients were included. CRUSADE, ACUITY, ACTION and GRACE were the scores externally validated. The rate of in-hospital major bleeding was 7.80% (5.5-9.2), 2.05% (1.5-3.0) being related to access and 2.70% (1.7-4.0) needing transfusions. When evaluating all ACS patients, ACTION, CRUSADE and ACUITY performed similarly (AUC 0.75: 0.72-0.79; 0.71: 0.64-0.80 and 0.71: 0.63-0.77 respectively) when compared to GRACE (0.66; 0.64-0.67, all confidence intervals 95%). When appraising only STEMI patients, all the scores performed similarly, while CRUSADE was the only one externally validated for NSTEMI. For ACTION and ACUITY, accuracy increased for radial access patients, while no differences were found for CRUSADE.
  
  
  CONCLUSIONS
  ACTION, CRUSADE and ACUITY perform similarly to predict risk of bleeding in ACS patients. The CRUSADE score is the only one externally validated for NSTEMI, while accuracy of the scores increased with radial access.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy ; Cardiology Department, Assuit University, Assuit, Egypt.
authors.forename: Salma
authors.initials: S
authors.lastname: Taha
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Omedè
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Montefusco
authors.affiliation: Washington University School of Medicine, Washington, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.affiliation: Columbia University Medical Center and the Cardiovascular Research Foundation, New York, USA.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Città Della Salute e Della Scienza Turin, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
keywords: acute coronary syndromes; bleeding; risk scores