Abstract 19844: Impact of the CRUSADE, ACUITY and TIMI Major Bleeding Definitions on in-Hospital Mortality in Patients with Non-ST Elevation Acute Myocardial Infarction.
Background: Major bleeding is associated with increased mortality in patients with non-ST elevation acute myocardial infarction (NSTEMI). Although several major bleeding definitions exist, the predictive accuracy of different scales has rarely been compared. We assessed the impact of major bleeding (MB), defined by the CRUSADE, ACUITY and TIMI criteria, on in-hospital mortality in patients with NSTEMI.
Methods: Retrospectively, between 2004 and 2009, 794 consecutive patients with the definitive diagnosis of NSTEMI were evaluated. MB was defined by the CRUSADE scale (intracraneal bleeding, retroperitoneal bleeding, a fall in hematocrit ≥12% (baseline to nadir), any red blood cell transfusion in which baseline hematocrit was ≥28%, or any in which this was <28% with overt bleeding), ACUITY scale (intracranial, intraocular, or retroperitoneal bleeding; access site bleeding with intervention; hematoma 5 cm; hemoglobin drop 3g/dL with source or 4g/dL without source; or transfusion, and by the TIMI scale (intracranial bleeding; hemoglobin drop >5g/dL or hematocrit dorp >15%). Separate adjusted models assessed the impact of MB established by each scale on the in-hospital mortality.
Results: 696 (88%) patients underwent cardiac catheterization (91% via radial approach). 519 (74.5%) were revascularized. 41 (5.2%) died in-hospital. CRUSADE-, ACUITY- and TIMI-MB occurred in 15.4%, 11.8%, and 5.2%, respectively. In a covariate-adjusted multivariable model including each scale only, both CRUSADE and ACUITY-MB was an independent predictor of in-hospital mortality (Odds ratio 3.2, [95% confidence interval: 1.2–5.4] and 2.6 [1.6–4.1], respectively (p<0.01). TIMI-MB was not an independent predictor of in-hospital death (1.6 [0.5–5.2] (p=0.3).
Conclusions: CRUSADE- and ACUITY- MB are both independent predictors of in-hospital mortality in NSTEMI patients. Although CRUSADE- and ACUITY-MB are powerfull for predicting in-hospital mortality in NSTEMI patients, CRUSADE-MB is more common and thus identifies more patients at risk from MB.
- © 2010 by American Heart Association, Inc.