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Background: Bleeding is a common and frequently devastating complication in acute coronary syndrome (ACS), and critical to evaluate in the current era of ACS management involving invasive strategies and potent antithrombotics. Risk models remain under-utilised in this setting but may guide therapy, and we compared their performance for predicting bleeding in ACS patients in this meta-analysis.
Methods: Medline, Embase, Cochrane and Scopus were searched for relevant articles from 1980 to 30 June 2016 assessing external validation of ACS bleeding risk scores. Two authors independently reviewed the searched studies for inclusion for pooled analyses with random effects models.
Results: Amongst 1662 articles searched, 62 full-texts were reviewed and 20 studies with 22,256 patients included for analyses. C-statistics (95% confidence interval)/number of studies for predicting major bleeding for each risk model were CRUSADE 0.713 (0.659 – 0.767)/13, ACUITY 0.702 (0.557 – 0.847)/4, Mehran 0.743 (0.719 – 0.767)/4, ACTION 0.767 (0.737 – 0.797)/3, HASBLED 0.636 (0.460 – 0.812)/3, GRACE 0.689 (0.473 – 0.905)/2 and CHA2DS2-VASc 0.580 (0.492 – 0.667)/2 respectively. Only the CRUSADE score had subgroup analyses in at least 3 studies, and it performed better in STEMI vs NSTEMI (c=0.791 vs 0.747), radial vs femoral (c=0.826 vs 0.734) and invasive vs non-invasive strategy (c=0.750 vs 0.625). Heterogeneity of bleeding definitions and paucity of literature of models except CRUSADE were important limitations.
Conclusions: The ACS bleeding-specific scores had moderate discrimination and performed better than other scores. The CRUSADE score was the most widely studied and validated, performing better in STEMI, radial access and invasive strategy subgroups.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-324
- 2017 American College of Cardiology Foundation