title: A new scoring system (DAIGA) for predicting bleeding complications in atrial fibrillation patients after drug-eluting stent implantation with triple antithrombotic therapy.
abstract: BACKGROUND
  No scoring system for evaluating the bleeding risk of atrial fibrillation (AF) patients after drug-eluting stent (DES) implantation with triple antithrombotic therapy (TAT) is available. We aimed to develop a new scoring system for predicting bleeding complications in AF patients after DES implantation with TAT.
  
  
  RESULTS
  Between April 2007 and April 2014, 227 AF patients undergoing DES implantation with TAT were enrolled. Bleeding incidence defined as Bleeding Academic Research Consortium criteria≥2 was investigated and predictors of bleeding complications were evaluated using multivariate analysis. Bleeding complications occurred in 58 patients (25.6%) during follow-up. Multivariate analysis revealed dual antiplatelet therapy (DAPT) continuation (OR 3.33, P=0.01), age>75 (OR 2.14, P=0.037), international normalized ratio>2.2 (OR 5.82, P<0.001), gastrointestinal ulcer history (OR 3.06, P=0.037), and anemia (OR 2.15, P=0.042) as predictors of major bleeding complications. A score was created using the weighted points proportional to the beta regression coefficient of each variable. The DAIGA score showed better predictive ability for bleeding complications than the HAS-BLED score (AUC: 0.79 vs. 0.62, P=0.0003). Bleeding incidence was well stratified: 17.8% in low-risk (scores 0-1), 55.5% in moderate-risk (2-3), and 83.0% in high-risk (4-7) patients (P<0.001).
  
  
  CONCLUSIONS
  This scoring system is useful for predicting bleeding complications and risk stratification of AF patients after DES implantation with TAT.
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan. Electronic address: ovation17@gmail.com.
authors: Norihiro
authors: N
authors: Kobayashi
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Masahiro
authors: M
authors: Yamawaki
authors: Department of Cardiology, General Tokyo Hospital, Japan.
authors: Masatsugu
authors: M
authors: Nakano
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Keisuke
authors: K
authors: Hirano
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Motoharu
authors: M
authors: Araki
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Hideyuki
authors: H
authors: Takimura
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Yasunari
authors: Y
authors: Sakamoto
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Shinsuke
authors: S
authors: Mori
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Masakazu
authors: M
authors: Tsutsumi
authors: Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Japan.
authors: Yoshiaki
authors: Y
authors: Ito
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D004359:Drug Therapy, Combination / Q000379:methods; D054855:Drug-Eluting Stents; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D006470:Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007564:Japan; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D012107:Research Design; D018570:Risk Assessment / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents
keywords: Atrial fibrillation; Bleeding complications; Drug-eluting stent implantation; Triple antithrombotic therapy