Abstract 2027: Validation of a Bleeding Risk Score for Acute Coronary Syndromes
Background: a number of prospective registries have identified independent predictors of bleeding during hospitalization for acute coronary syndromes (ACS). However, no score is validated to estimate individual risk of bleeding in ACS.
Objectives and Methods: in order to create and validate a score for estimating risk of bleeding at admission of patients with ACS, independent predictors of bleeding reported in the GRACE registry ( Circulation 2007; 116 :2793–2801) were utilized according to the following rule: the presence of variables with odds ratio (OR) ≥ 2.5 in the GRACE registry added 3 points to the score, OR = 1.5–2.4 added 2 points and those with OR < 1.5 added 1 point. Only information available at admission were considered: previous history of bleeding (3 points), creatinine clearance < 30 ml/min (2 points), clearance = 30 – 60 ml/min (1 point), female gender (2 points), each 10 years of aging after 30 years old (1 point), ST-segment depression (1 point), peripheral artery disease (1 point), smoking (1 point). In order to validate the score, a sample of 383 consecutive individuals (66±12 yo, 58% males) admitted with ACS between 1999 and 2007 was studied. Inclusion criteria were defined as chest discomfort with at least one of the following: ST-segment elevation, ST-segment depression, T wave inversion, positive troponin or previous coronary artery disease. Major bleeding was defined as hematocrit fall ≥ 10%, blood transfusion of at least 2 units, intracerebral bleeding or fatal bleeding.
Results: incidence of major bleeding was 3.1%. The bleeding score statistically predicted major bleeding (C-statistics=0.66; 95%IC = 0.52– 0.80). Patients in the first two quartiles of score distribution (1– 4 points) experienced the lowest risk of bleeding (1.6%), those in the third quartile (6 points) had intermediate risk (2.7%) and individuals in the fourth quartile (7–10 points) had the highest risk observed (6%, P=0.089). When sample population was dichotomized according to the best cut-off point in risk discrimination, those with a score ≥ 7 had 6% risk of bleeding, compared to individuals with a score < 7 (1.9%, P=0.03).
Conclusion: the tested score discriminates bleeding risk and is a potentially useful tool in clinical decision during acute coronary syndromes.