In:
Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_1 ( 2021-11-16)
Abstract:
Introduction: Intense and prolonged antithrombotic treatment after acute coronary syndrome (ACS) reduces ischemia but increases bleeding. Risk prediction tools might help individualize antithrombotic treatment. Hypothesis: We have previously developed the ABC (age, biomarkers, clinical history) score for major bleeding in patients with atrial fibrillation. We hypothesized that the ABC score might be adapted for prediction of major bleeding in patients after coronary revascularization for ACS. Methods: A risk score was developed in 9,845 patients with ACS undergoing coronary revascularization in the PLATelet inhibition and patient Outcomes (PLATO) trial. Model discrimination and calibration was assessed using Harrell’s c-index and calibrations plots. Validation was performed in two external trial cohorts: Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) and Fragmin and Fast Revascularisation during Instability in Coronary Artery Disease (FRISC II). In addition, the novel score was compared to the PRECISE-DAPT and PARIS bleeding scores. Results: The ABC-ACS bleeding score was developed from 7,216 person-years of follow-up and 370 episodes of major bleeding in PLATO. Predictors of major bleeding, in order of relative strength, were age, growth differentiation factor-15 (GDF-15) and hemoglobin concentrations, type of P2Y 12 inhibitor and history of bleeding. The score showed good calibration, yielding c-indices of 0.71 in PLATO, 0.65 in TRACER and 0.70 in FRISC II, and performing better than the PRECISE-DAPT and PARIS scores (figure). Conclusions: The ABC-ACS bleeding score was internally and externally validated in three cohorts of patients with ACS and showed good discrimination and calibration. The ABC-ACS bleeding score performed better than other contemporary bleeding scores and might improve the decision-making process about intensity and duration of antithrombotic treatment.
Type of Medium:
Online Resource
ISSN:
0009-7322
,
1524-4539
DOI:
10.1161/circ.144.suppl_1.13221
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
1466401-X
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