Bleeding risk in patients with acute coronary syndrome in a Turkish population results from the Turkish acute coronary syndrome registry (TACSER) study

Objective Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. Methods This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (>= 25) or low (= 25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 +/- 15.7 vs 18.4 +/- 13.6,P = 25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 +/- 1.7 vs 13.8 +/- 1.9,P < .001) and lower creatinine clearance (70.7 +/- 27.5 vs 88.7 +/- 26.3,P < .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%,P = .11). Conclusions The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed that the PRECISE-DAPT score may help physicians determine the type and duration of DAPT, especially in patients with ACS in Turkey

Combined value of left ventricular ejection fraction and the Model for End-Stage Liver Disease (MELD) score for predicting mortality in patients with acute coronary syndrome who were undergoing percutaneous coronary intervention

Abstract Background The purpose of the study was to investigate whether the addition of left ventricular ejection fraction (LVEF) to the MELD score enhances the prediction of mortality in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods This retrospective study analyzed 846 consecutive patients with ACS undergoing PCI who were not receiving previous anticoagulant therapy. The patients were grouped as survivors or non-survivors. The MELD score and LVEF were calculated in all patients. The primary end point was all-cause death during the median follow-up of 28 months. Results During the follow-up, there were 183 deaths (21.6%). MELD score was significantly higher in non-survivors than survivors (10.1 ± 4.4 vs 7.8 ± 2.4, p <  0.001). LVEF was lower in non-survivors compared with survivors (41.3 ± 11.8% vs. 47.5 ± 10.0%, p <  0.001). In multivariate analysis, both MELD score and LVEF were independent predictors of total mortality. (HR: 1.116, 95%CI: 1.069–1.164, p <  0.001; HR: 0.972, 95%CI: 0.958–0.986, p <  0.001, respectively). The addition of LVEF to MELD score was associated with significant improvement in predicting mortality compared with the MELD score alone (AUC:0.733 vs 0.690, p <  0.05). Also, the combining LVEF with MELD score improved the reclassification (NRI:24.6%, p <  0.001) and integrated discrimination (IDI:0.045, p <  0.001) of patients compared with MELD score alone. Conclusions Our study demonstrated that the combining LVEF with MELD score may be useful to predict long-term survival in patients with ACS who were undergoing PCI

Additional file 1: of Combined value of left ventricular ejection fraction and the Model for End-Stage Liver Disease (MELD) score for predicting mortality in patients with acute coronary syndrome who were undergoing percutaneous coronary intervention

Subgroup analysis according to gender (Tables S6-S8). (ZIP 27 kb

Prognostic value of rising mean platelet volume during hospitalization in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract Background The prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients. Methods Four hundred eighty consecutive STEMI patients were enrolled in this retrospective study. The patients were grouped as survivors (n = 370) or non-survivors (n = 110). MPV at admission, and at 48–72 h was evaluated. Change in MPV (MPV at 48–72 h minus MPV on admission) was defined as ΔMPV. Results At follow-up, long-term mortality was 23%. The non-survivors had a high ΔMPV than survivors (0.37 (− 0.1–0.89) vs 0.79 (0.30–1.40) fL, p <  0.001). A high ΔMPV was an independent predictor of all cause mortality ((HR: 1.301 [1.070–1.582], p = 0.008). Morever, for long-term mortality, the AUC of a multivariable model that included age, LVEF, Killip class, and history of stroke/TIA was 0.781 (95% CI:0.731–0.832, p <  0.001). When ΔMPV was added to a multivariable model, the AUC was 0.800 (95% CI: 0.750–0.848, z = 2.256, difference p = 0.0241, Fig. 1). Also, the addition of ΔMPV to a multivariable model was associated with a significant net reclassification improvement estimated at 24.5% (p = 0.027) and an integrated discrimination improvement of 0.014 (p = 0.0198). Conclusions Rising MPV during hospitalization in STEMI patients treated with pPCI was associated with long-term mortality