Albert Ariza-Solé1, Carme Guerrero1, Francesc Formiga1, Jaime Aboal2, Emad Abu-Assi3, Francisco Marín4, Héctor Bueno5, Oriol Alegre1, Ramón López-Palop6, María T Vidán7, Manuel Martínez-Sellés7, Pablo Díez-Villanueva8, Pau Vilardell2, Alessandro Sionis9, Miquel Vives-Borrás9, Juan Sanchís10, Jordi Bañeras11, Agnès Rafecas11, Cinta Llibre12, Javier López13, Violeta González-Salvado14, Àngel Cequier1. 1. Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. 2. Cardiology Department, Hospital Universitari Josep Trueta, Girona, Spain. 3. Cardiology Department, Hospital Álvaro Cunqueiro, Vigo, Spain. 4. Cardiology Department, Hospital Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Murcia, Spain. 5. Cardiology Department, Hospital Doce de Octubre, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain. 6. Cardiology Department, Hosptal Universitario San Juan, Alicante, Spain. 7. Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain. 8. Cardiology Department, Hospital Unversitario La Princesa, Madrid, Spain. 9. Cardiology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. 10. Cardiology Department, Hospital Clínico de Valencia, INCLIVA, Universidad de Valencia, CIBER CV, Valencia, Spain. 11. Cardiology Department, Hospital de la Vall d'Hebron, CIBER CV, Barcelona, Spain. 12. Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain. 13. Cardiology Department, Hospital Clínico de Valladolid, Valladolid, Spain. 14. Cardiology Department, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain.
Abstract
BACKGROUND: Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. METHODS: The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). RESULTS: Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). CONCLUSION: Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal. Schattauer GmbH Stuttgart.
BACKGROUND:Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. METHODS: The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). RESULTS: Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). CONCLUSION: Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal. Schattauer GmbH Stuttgart.