Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

Introduction and objective: Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. Methods: All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). Results: We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). Conclusions: Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia

Impacto de la fragilidad y otros síndromes geriátricos en el manejo y pronóstico vital del anciano con síndrome coronario agudo

[spa] ANTECEDENTES: La incidencia de síndrome coronario agudo (SCA) es especialmente elevada en el anciano. Los pacientes ancianos están poco representados en los ensayos clínicos, suelen recibir tratamientos más conservadores y con frecuencia presentan fragilidad y otros síndromes geriátricos. Por ello existe escasa información sobre el manejo global del síndrome coronario agudo en los pacientes de edad avanzada y sobre el papel pronóstico que puedan jugar las variables vinculadas al envejecimiento en este escenario clínico. MÉTODOS: El proyecto comprende tres estudios. En el primero se ha realizado un análisis retrospectivo de un gran registro español (CMBD del Ministerio de Sanidad) con la finalidad de describir las tendencias y mortalidad en el manejo del IAM con elevación del segmento ST en los pacientes de 75 años o más durante un periodo de 10 años. En el segundo se ha realizado un registro (registro LONGEVO-SCA) en el que se han incluido prospectivamente a partir de marzo de 2016 un total de 532 pacientes consecutivos con síndrome coronario agudo sin elevación del segmento ST de 80 años o más ingresados en 44 hospitales de diferente complejidad de todo el territorio español. Se ha realizado una valoración clínica y geriátrica exhaustiva durante el ingreso, haciendo especial hincapié en la fragilidad (escala FRAIL), y un seguimiento a los 6 meses. En el tercero se ha realizado un análisis del impacto de la fragilidad en la cohorte del registro LONGEVO-SCA sobre el manejo clínico, la calidad de vida y la mortalidad. DISCUSIÓN: Los resultados de este proyecto pueden mejorar notablemente el conocimiento del impacto de la fragilidad y los otros síndromes geriátricos en el pronóstico del anciano con SCA, pudiendo así contribuir a mejorar su manejo clínico global. El progresivo envejecimiento poblacional y la incidencia de SCA en el anciano y sus particularidades (complejidad, incidencia de complicaciones, consumo de recursos sanitarios, etc.) han convertido el manejo de esta patología en este segmento poblacional en un problema de salud pública de primera magnitud.[eng] BACKGROUND: The incidence of acute coronary syndrome (ACS) is especially high in the elderly. Elderly patients are underrepresented in clinical trials, tend to receive more conservative treatments and frequently have frailty and other geriatric syndromes. Therefore, there is scarce information on the global management of acute coronary syndrome in elderly patients and on the prognostic role that variables related to aging can play in this clinical scenario. METHODS: The project comprises three studies. In the first one, a retrospective analysis of a large spanish registry (CMBD of the Ministry of Health) was carried out in order to describe the trends and mortality in the management of STEMI (ST elevation myocardial infarction) in patients with 75 years old or more in a period of 10 years. In the second one, we performed a registry (LONGEVO-SCA registry) in which a total of 532 consecutive patients with NSTEMI (non-ST elevation myocardial infarction) of 80 years or more admitted in 44 spanish hospitals of different complexity were prospectively included since march 2016. A thorough clinical and geriatric assessment was carried out during admission, with special emphasis on frailty (FRAIL scale) and follow-up after 6 months. In the third one, an analysis of the impact of frailty in the LONGEVO-SCA registry cohort on clinical management, quality of life and mortality was carried out. DISCUSSION: The results of this project can significantly improve the knowledge of the impact of frailty and other geriatric syndromes on the prognosis of the elderly with ACS, thus being able to contribute to improving their overall clinical management. The progressive aging population and the incidence of ACS in the elderly and its particularities (complexity, incidence of complications, consumption of health resources, etc.) have made the management of this pathology in this population a public health problem of the first magnitude

Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes?

Introduction and objective: Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. Methods: All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). Results: We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). Conclusions: Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia