2016


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2016/№1

Clinical predictors of hemorrhagic complications in ST segment elevation acute myocardial infarction

Kochergina A. M.1, Kashtalap V. V.1, Leonova V. O.2, Barbarash O. L.1
1 – Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” at the Siberian Branch of the Russian Academy of Medical Sciences, Sosnovy Bulvar 6
2 – State Budgetary Educational Institution of Higher Professional Education, “Kemerovo State Medical Academy” of the RF Ministry of Health Care, Voroshilova 22a, Kemerovo 650029

Keywords: bleeding, ACS, risk of bleeding

DOI: 10.18087/rhj.2016.1.2148

Background. The issue of hemorrhagic complications in ACS as a consequence of active, dual antiplatelet therapy (DAPT) and transcutaneous coronary interventions (TCI) remains relevant. Evaluating the incidence of hemorrhagic complications is difficult. Aim. To evaluate a possibility of using different scales for prediction of hemorrhagic complications in the hospital period of ST segment elevation acute IM (STEMI). Materials and methods. This retrospective study included 407 patients (mean age, 61.75±10.46) admitted for acute STEMI in 2012. Two groups were formed based on the presence of documented hemorrhagic complications. Possible risk of hemorrhage was evaluated by CRUSADE, ACTION, and REACH scales. Results. Patients with hemorrhagic complications were significantly older (67.62±9.20 vs. 60.7±11.67, р=0.0003) and they were mostly female (60 % vs. 26.61 %; р=0,000). Glomerular filtration rate (GFR) was reduced in the group of patients with hemorrhages (58.37±18.21 vs. 71.0±21.12 ml / min / 1.73 m2, р=0.0003) on admission. Groups with and without hemorrhagic complications did not differ in severity of coronary atherosclerosis and the risk of hemorrhages evaluated by the CRUSADE scale. Significant differences were observed in evaluation of the risk using the ACTION scale (scores 40.2±3.39 vs. 44.02±5.8, р=0.000). Conclusion. STEMI patients with hemorrhagic complications were characterized by traditional risk factors for hemorrhages, such as age, female gender, and renal dysfunction. The ACTION scale can be used for stratification of hemorrhage risk in patients with STEMI.
  1. Daugherty SL, Thompson LE, Kim S, Rao SV, Subherwal S, Tsai TT et al. Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National cardiovascular Data Registry. J Am Coll Cardiol. 2013 May 21;61 (20):2070–8.
  2. Abu-Assi E, Raposeiras-Roubín S, García-Acuña JM, González-Juanatey JR. Bleeding risk stratification in an era of aggressive mana­gement of acute coronary syndromes. World J Cardiol. 2014 Nov 26;6 (11):1140–8.
  3. Kadakia MB, Desai NR, Alexander KP, Chen AY, Foody JM, Cannon CP et al. Use of anticoagulant agents and risk of bleeding among patients admitted with myocardial infarction: a report from the NCDR ACTION Registry – GWTG (National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry – get with the guidelines). JACC Cardiovasc Interv. 2010 Nov;3 (11):1166–77.
  4. Кочергина А. М., Кочергин Н. А. Проблема кровотечений при проведении чрескожных коронарных вмешательств у пожилых пациентов с острым коронарным синдромом. Клиническая медицина. 2015;93 (4):5–11.
  5. Харченко М. С., Эрлих А. Д., Косенков Е. И., Масенко В. П., Грацианский Н. А. Добавление уровня цистатина C к подсчету баллов по шкале GRACE повышает точность оценки риска кровотечений у неинвазивно леченных больных с острым коронарным синдромом. Кардиоваскулярная терапия и профилактика. 2012;11 (6):38–43.
  6. Gage BF, Yan Y, Milligan PE, Waterman AD, Culverhouse R, Rich MW, Radford MJ. Clinical classification schemes for predicting hemorrhage: results from the National Registry of Atrial Fibrillatiion. Am Heart J. 2006 Mar;151 (3):713–9.
  7. Buğan B, Yıldırım E, Çelik T. Reperfusion primary percutaneous coronary intervention in the elderly: catheterization or conservative approach? J Clin Anal Med. 2014;5 (2):164–7.
  8. Rao SV. Hemorrhage in patients with acute coronary syndrome: from annoying observation to major challenge. Rev Esp Cardiol. 2010 Jan;63 (1):1–4.
  9. Alexander KP, Newby LK, Armstrong PW, Cannon CP, Gibler WB, Rich MW et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007 May 15;115 (19):2570–89.
  10. Mehta RH, Granger CB, Alexander KP, Bossone E, White HD, Sketch MH. Reperfusion strategies for acute myocardial infarction in the elderly: benefits and risks. J Am Coll Cardiol. 2005 Feb 15;45 (4):471–8.
  11. Rao SV, McCoy LA, Spertus JA, Krone RJ, Singh M, Fitzgerald S, Peterson ED. An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention. JACC Cardiovasc Interv. 2013 Sep;6 (9):897–904.
  12. Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC / AHA Guidelines) bleeding score. Circulation. 2009 Apr 14;119 (14):1873–82.
  13. Daugherty SL, Thompson LE, Kim S, Rao SV, Subherwal S, Tsai TT et al. Patterns of use and comparative effectiveness of bleeding avoidance strategies in men and women following percutaneous coronary interventions: an observational study from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2013 May 21;61 (20):2070–8.
  14. Doyle BJ, Ting HH, Bell MR, Lennon RJ, Mathew V, Singh M et al. Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv. 2008 Apr;1 (2):202–9.
  15. Zielinska M, Kaczmarek K, Krekora J, Koniarek W. Early clinical results of primary angioplasty and stenting in acute myocardial infarction in the elderly. New Medicine. 2003;3:49–52.
  16. Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC / AHA Guidelines) bleeding score. Circulation. 2009 Apr 14;119 (14):1873–82.
  17. Diercks DB, Owen KP, Kontos MC, Blomkalns A, Chen AY, Miller C et al. Gender differences in time to presentation for myocardial infarction before and after a national women's cardiovascular awareness campaign: a temporal analysis from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress ADverse Outcomes with Early Implementation (CRUSADE) and the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (NCDR ACTION Registry-GWTG). Am Heart J. 2010 Jul;160 (1):80–7.
  18. Ducrocq G, Wallace JS, Baron G, Ravaud P, Alberts MJ, Wilson PW et al. Risk score to predict serious bleeding in stable outpatients with or at risk of atherothrombosis. Eur Heart J. 2010 May;31 (10):1257–65.
  19. Mathews R, Peterson ED, Chen AY, Wang TY, Chin CT, Fonarow GC et al. In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care: derivation and validation of a model from the ACTION Registry (R) – GWTG. Am J Cardiol. 2011 Apr 15;107 (8):1136–43.
  20. Chin CT, Chen AY, Wang TY, Alexander KP, Mathews R, Rumsfeld JS et al. Risk adjustment for in-hospital mortality of contemporary patients with acute myocardial infarction: the acute coronary treatment and intervention outcomes network (ACTION) registry-get with the guidelines (GWTG) acute myocardial infarction mortality model and risk score. Am Heart J. 2011 Jan;161 (1):113–22.
Kochergina A. M., Kashtalap V. V., Leonova V. O., Barbarash O. L.Clinical predictors of hemorrhagic complications in ST segment elevation acute myocardial infarction. Russian Heart Journal. 2016;15 (1):3–8

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