• Albert Ariza-Solé, Carme Guerrero, Francesc Formiga, Jaime Aboal, Emad Abu-Assi, Francisco Marín, Héctor Bueno, Oriol Alegre, Ramón López-Palop, María T Vidán, Manuel Martínez-Sellés, Pablo Díez-Villanueva, Pau Vilardell, Alessandro Sionis, Miquel Vives-Borrás, Juan Sanchís, Jordi Bañeras, Agnès Rafecas, Cinta Llibre, Javier López, Violeta González-Salvado, Àngel Cequier, and LONGEVO-SCA Registry Investigators.
• Cardiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
• Thromb. Haemost. 2018 Mar 1; 118 (3): 581-590.

BackgroundBleeding 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.MethodsThe 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).ResultsMean 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).ConclusionComorbidity 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.

22 keywords...

hide…