title: Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?
abstract: OBJECTIVE
  Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia.
  
  
  METHODS
  All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC).
  
  
  RESULTS
  We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044).
  
  
  CONCLUSIONS
  Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia.
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Garay
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. Electronic address: aariza@bellvitgehospital.cat.
authors.forename: Albert
authors.initials: A
authors.lastname: Ariza-Solé
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Formiga
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Lorente
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: José C
authors.initials: JC
authors.lastname: Sánchez-Salado
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Joel
authors.initials: J
authors.lastname: Salazar-Mendiguchía
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Gerard
authors.initials: G
authors.lastname: Roura
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Guillem
authors.initials: G
authors.lastname: Muntané
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Alegre
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Lara
authors.initials: L
authors.lastname: Fuentes
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Joan A
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.affiliation: Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000368:Aged; D000740:Anemia / Q000150:complications* / Q000453:epidemiology; D000789:Angina, Unstable; D015897:Comorbidity; D005260:Female; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment
keywords: Acute coronary syndromes; Anemia; Bleeding risk stratification; Comorbidities; Comorbilidades; Estratificação de risco de hemorragia; Síndromes coronárias agudas