Thromb Haemost 2018; 118(05): 929-938
DOI: 10.1055/s-0038-1635259
Atherosclerosis and Ischaemic Disease
Schattauer GmbH Stuttgart

Prediction of Post-Discharge Bleeding in Elderly Patients with Acute Coronary Syndromes: Insights from the BleeMACS Registry

Alberto Garay
1   Bellvitge Hospital, Barcelona, Spain
,
Albert Ariza-Solé
1   Bellvitge Hospital, Barcelona, Spain
,
Francesc Formiga
1   Bellvitge Hospital, Barcelona, Spain
,
Sergio Raposeiras-Roubín
2   Hospital Álvaro Cunqueiro, Vigo, Spain
,
Emad Abu-Assi
2   Hospital Álvaro Cunqueiro, Vigo, Spain
,
José C. Sánchez-Salado
1   Bellvitge Hospital, Barcelona, Spain
,
Victòria Lorente
1   Bellvitge Hospital, Barcelona, Spain
,
Oriol Alegre
1   Bellvitge Hospital, Barcelona, Spain
,
Jose Paulo Simao Henriques
3   Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Fabrizio D'Ascenzo
4   San Giovanni Battista Molinette Hospital, Turin, Italy
,
Jorge Saucedo
5   NorthShore University Hospital, Chicago, Illinois, United States
,
José Ramón González-Juanatey
6   Clinical Hospital, Santiago de Compostela, Spain
,
Stephen B. Wilton
7   Libin Cardiovascular Institute of Alberta, Calgary, Canada
,
Wouter J. Kikkert
3   Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
,
Iván Nuñez-Gil
8   San Carlos Hospital, Madrid, Spain
,
Xiantao Song
9   Anzhen Hospital, Beijing, Japan
,
Dimitrios Alexopoulos
10   University Patras Hospital, Patras, Greece
,
Christoph Liebetrau
11   Kerckhoff Heart and Thorax Center, Frankfurt, Germany
,
Tetsuma Kawaji
12   University Graduate School of Medicine, Kyoto, Japan
,
Claudio Moretti
4   San Giovanni Battista Molinette Hospital, Turin, Italy
,
Zenon Huczek
13   University Clinical Hospital, Warsaw, Poland
,
Shao-Ping Nie
14   Beijing Anzhen Hospital, Capital Medical University, Beijing, Japan
,
Toshiharu Fujii
15   Tokai University School of Medicine, Tokyo, Japan
,
Luis Correia
16   Hospital Sao Rafael, Salvador, Brazil
,
Masa-aki Kawashiri
17   University Graduate School of Medicine, Kanazawa, Japan
,
José María García-Acuña
6   Clinical Hospital, Santiago de Compostela, Spain
,
Danielle Southern
7   Libin Cardiovascular Institute of Alberta, Calgary, Canada
,
Emilio Alfonso
8   San Carlos Hospital, Madrid, Spain
,
Belén Terol
8   San Carlos Hospital, Madrid, Spain
,
Dongfeng Zhang
9   Anzhen Hospital, Beijing, Japan
,
Yalei Chen
9   Anzhen Hospital, Beijing, Japan
,
Ioanna Xanthopoulou
10   University Patras Hospital, Patras, Greece
,
Neriman Osman
11   Kerckhoff Heart and Thorax Center, Frankfurt, Germany
,
Helge Möllmann
11   Kerckhoff Heart and Thorax Center, Frankfurt, Germany
,
Hiroki Shiomi
12   University Graduate School of Medicine, Kyoto, Japan
,
Francesca Giordana
4   San Giovanni Battista Molinette Hospital, Turin, Italy
,
Fiorenzo Gaita
4   San Giovanni Battista Molinette Hospital, Turin, Italy
,
Michal Kowara
13   University Clinical Hospital, Warsaw, Poland
,
Krzysztof Filipiak
13   University Clinical Hospital, Warsaw, Poland
,
Xiao Wang
14   Beijing Anzhen Hospital, Capital Medical University, Beijing, Japan
,
Yan Yan
14   Beijing Anzhen Hospital, Capital Medical University, Beijing, Japan
,
Jing-Yao Fan
4   San Giovanni Battista Molinette Hospital, Turin, Italy
,
Yuji Ikari
15   Tokai University School of Medicine, Tokyo, Japan
,
Takuya Nakahashi
17   University Graduate School of Medicine, Kanazawa, Japan
,
Kenji Sakata
17   University Graduate School of Medicine, Kanazawa, Japan
,
Masakazu Yamagishi
17   University Graduate School of Medicine, Kanazawa, Japan
,
Oliver Kalpak
18   University Clinic of Cardiology, Skopje, Macedonia
,
Sasko Kedev
18   University Clinic of Cardiology, Skopje, Macedonia
,
Angel Cequier
1   Bellvitge Hospital, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

23 November 2017

09 February 2018

Publication Date:
03 April 2018 (online)

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Abstract

Background A poor ability of recommended risk scores for predicting in-hospital bleeding has been reported in elderly patients with acute coronary syndromes (ACS). No study assessed the prediction of post-discharge bleeding in the elderly. The new BleeMACS score (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome), was designed to predict post-discharge bleeding in ACS patients. We aimed to assess the predictive ability of the BleeMACS score in elderly patients.

Methods We assessed the incidence and characteristics of severe bleeding after discharge in ACS patients aged ≥ 75 years. Bleeding was defined as any intracranial bleeding or bleeding leading to hospitalization and/or red blood transfusion, occurring within the first year after discharge. We assessed the predictive ability of the BleeMACS score according to age by Fine–Gray proportional hazards regression analysis, calculating receiver-operating characteristic (ROC) curves and the area under the ROC curves (AUC).

Results The BleeMACS registry included 15,401 patients of whom 3,376/15,401 (21.9%) were aged ≥ 75 years. Elderly patients were more commonly treated with clopidogrel and less often treated with ticagrelor or prasugrel. Of 3,376 elderly patients, 190 (5.6%) experienced post-discharge bleeding. The incidence of bleeding was moderately higher in elderly patients (hazard ratio [HR], 2.31, 95% confidence interval [CI], 1.92–2.77). The predictive ability of the BleeMACS score was moderately lower in elderly patients (AUC, 0.652 vs. 0.691, p = 0.001).

Conclusion Elderly patients with ACS had a significantly higher incidence of post-discharge bleeding. Despite a lower predictive ability in older patients, the BleeMACS score exhibited an acceptable performance in these patients.