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Thromb Haemost 2023; 123(02): 255-266
DOI: 10.1055/a-1964-8247
Atherosclerosis and Ischaemic Disease

External Validation of the ACUITY/HORIZON Bleeding Risk Score among Acute Coronary Syndrome Patients in Thai PCI Registry

Worawut Roongsangmanoon 
1   Division of Cardiology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak Campus, Nakhon Nayok, Thailand
,
Ply Chichareon
2   Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
,
Teeranan Angkananard
1   Division of Cardiology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak Campus, Nakhon Nayok, Thailand
,
Pannipa Suwannasom
3   Northern Region Heart Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
,
Mann Chandavimol
4   Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Thosaphol Limpijankit
4   Division of Cardiology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Suphot Srimahachota
5   Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
,
Siriporn Athisakul
5   Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
,
Pisit Hutayanon
6   Cardiology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
,
Songsak Kiatchoosakun
7   Cardiology unit, Department of Medicine, Faculty of Medicine, Khonkaen University, Khon Kaen, Khon Kaen, Thailand
,
Praprut Thanakitcharu
8   Cardiac center, Sunpasitthiprasong Hospital Ubon Ratchathani, Ubon Ratchathani, Thailand
,
Montri Charoenpanichsunti
9   Cardiac Center, Phyathai Sriracha General Hospital, Chonburi, Thailand
,
Prajongjit Chamsaard
10   Cardiology Unit, Bhumibol Adulyadej Hospital, Bangkok, Thailand
,
Sukanya Siriyotha
11   Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Ammarin Thakkinstian
11   Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Nakarin Sansanayudh
12   Cardiology Unit, Department of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
› Author Affiliations Funding This study was funded by Health System Research Institute, the Ministry of Public Health, Thailand.
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Abstract

Background External validation is essential before implementing a predictive model in clinical practice. This analysis validated the performance of the ACUITY/HORIZON risk score in the most contemporary Thai PCI registry.

Methods The ACUITY/HORIZON model was applied and validated externally in 12,268 ACS (acute coronary syndrome) patients. For revision and updating models, the regression coefficientd of all predictors were re-estimated and then additional predictors were stepwise selected from multivariate analysis.

Results In-hospital bleeding defined by the BARC (Bleeding Academic Research Consortium) criteria was 1.3% (161 patients) and 2.3% (285 patients) by the ACUITY criteria. The calibration of both scales demonstrated overestimation of the original model with C-statistic values of 0.704 for ACUITY major bleeding and 0.793 for BARC 3 or 5 bleeding. For ACUITY major bleeding, the discriminatory power of the update model improved substantially when congestive heart failure (CHF), prior vascular disease as well as body mass index were considered. The update model demonstrated good calibration and C-statistic of 0.747 and 0.745 with no white blood cell (WBC) count. For BARC 3 or 5 bleeding, good calibration and discriminatory capacity could be observed when CHF and prior vascular disease were added in the update models, with an excellent C-statistic of 0.838, and a lower C-statistic value of 0.835 was obtained in the absence of WBC count.

Conclusion The ACUITY/HORIZON score was successfully validated in contemporary predictive and risk-adjustment models for PCI-related bleeding. The update models had good operating characteristics in patients from a real-world ACS population irrespective of bleeding definitions.

Keywords

ACUITY/HORIZON risk score - acute coronary syndrome - percutaneous coronary intervention - in-hospital major bleeding

Supplementary Material



Publication History

Received: 28 March 2022

Accepted: 18 October 2022

Accepted Manuscript online:
20 October 2022

Article published online:
31 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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