Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study.
Acute Coronary Syndrome
/ therapy
Aged
Aged, 80 and over
Anemia
/ epidemiology
Creatinine
/ metabolism
Dual Anti-Platelet Therapy
/ adverse effects
Female
Hemoglobins
/ metabolism
Hemorrhage
/ chemically induced
Hospital Mortality
Humans
Male
Middle Aged
Percutaneous Coronary Intervention
Postoperative Hemorrhage
/ chemically induced
Registries
Renal Insufficiency, Chronic
/ epidemiology
Risk Assessment
Risk Factors
Secondary Prevention
Sex Factors
Turkey
PRECISE-DAPT score
acute coronary syndrome
dual antiplatelet therapy
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
01
11
2019
revised:
16
04
2020
accepted:
09
05
2020
pubmed:
28
6
2020
medline:
7
9
2021
entrez:
28
6
2020
Statut:
ppublish
Résumé
Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE-DAPT scores. The mean PRECISE-DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE-DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P ˂ .001). Among the females, the rate of patients with a PRECISE-DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P ˂ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P ˂ .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%, P = .11). The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed that the PRECISE-DAPT score may help physicians determine the type and duration of DAPT, especially in patients with ACS in Turkey.
Substances chimiques
Hemoglobins
0
Creatinine
AYI8EX34EU
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13271Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Stichting European Society for Clinical Investigation Journal Foundation.
Références
Montalescot G, Brieger D, Dalby AJ, Park SJ, Mehran R. Duration of dual antiplatelet therapy after coronary stenting: a review of the evidence. J Am Coll Cardiol. 2015;66:832-847.
Navarese EP, Andreotti F, Schulze V, et al. Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials. BMJ. 2015;350:h1618.
Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494-550.
Kazi DS, Leong TK, Chang TI, Solomon MD, Hlatky MA, Go AS. Association of spontaneous bleeding and myocardial infarction with long-term mortality after percutaneous coronary intervention. J Am Coll Cardiol. 2015;65:1411-1420.
Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of THA European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with THA special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35:2541-2619.
Mauri L, Kereiakes DJ, Yeh RW, et al. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med. 2014;371:2155-2166.
Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: a report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016;68:1082-1115.
Coresh J, Auguste P. Reliability of GFR formulas based on serum creatinine, with special reference to the MDRD Study equation. Scand J Clin Lab Invest. 2008;68(sup241):30-38.
Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJ, Lip GY. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-1100.
Mehran R, Baber U, Steg PG, et al. Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet. 2013;382(9906):1714-1722.
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC / EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40(2):87-165.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or morecorrelated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44(3):837-845.
Costa F, van Klaveren D, James S, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient data sets from clinical trials. Lancet. 2017;389(10073):1025-1034.
Li L, Geraghty OC, Mehta Z, Rothwell PM. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. Lancet. 2017;390(10093):490-499.
Dauerman HL, Lessard D, Yarzebski J, Gore JM, Goldberg RJ. Bleeding complications in patients with anemia and acute myocardial infarction. Am J Cardiol. 2005;96(10):1379-1383.
Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556-2566.
Memişoğulları R. Yıldırım HA, Uçgun T, et al. Prevalence and etiology of anemias in the adult Turkish Population. Turk J Med Sci. 2012;42(6):957-963.
Abu-Assi E, Raposeiras-Roubin S, Cobas-Paz R, et al. Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients. Euro Intervention. 2018;13(16):1914-1922.
Süleymanlar G, Utaş C, Arinsoy T, et al. A population-based survey of chronic renal disease in Turkey-the CREDIT study. Nephrol Dial Transplant. 2011;26(6):1862-1871.
Ibrahim H, Schutt RC, Hannawi B, DeLao T, Barker CM, Kleiman NS. Association of immature platelets with adverse cardiovascular outcomes. J Am Coll Cardiol. 2014;64(20):2122-2129.
Latif F, Kleiman NS, Cohen DJ, et al. In-hospital and 1-year outcomes among percutaneous coronary intervention patients with chronic kidney disease in the era of drug-eluting stents: a report from the EVENT (Evaluation of Drug Eluting Stentsand Ischemic Events) registry. JACC Cardiovasc Interv. 2009;2(1):37-45.
Di Minno G, Martinez J, McKean ML, De La Rosa J, Burke JF, Murphy S. Platelet dysfunction in uremia. Multifaceted defect partially corrected by dialysis. Am J Med. 1985;79(5):552-559.
Remuzzi G, Benigni A, Dodesini P, et al. Reduced platelet thromboxane formation in uremia. Evidence for a functional cyclooxygenase defect. J Clin Invest. 1983;71(3):762-768.
Bonomini M, Dottori S, Amoroso L, Arduini A, Sirolli V. Increased platelet phosphatidyl serine exposure and caspase activation in chronic uremia. J Thromb Haemost. 2004;2(8):1275-1281.
Barron HV, Cannon CP, Murphy SA, et al. Association between white blood cell count, epicardial blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: a thrombolysis in myocardial infarction 10 substudy. Circulation. 2000;102(19):2329-2334.
Costa F, Van Klaveren D, Feres F, et al. Dual antiplatelet therapy duration based on ischemic and bleeding risks after coronary stenting. J Am Coll Cardiol. 2019;73(7):741-754.
Tanik VO, Cinar T, Arugaslan E, et al. The predictive value of PRECISE-DAPT Score for in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2019;70(5):440-447.
Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001-2015.
Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045-1057.