Bleeding Predictor in ST-Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Infarction: The Indonesian (INA) Bleeding Risk Score
Abstract
Background Acute myocardial infarction still become one of the leadingmortality cause in the world. Among these patients, ST elevation myocardial
infartion (STEMI) has the greatest mortality rate among other type of
Myocardial Infarction. When a myocard infarct patient have bleeding events,
mortality rate greatly increased. Up until now, there is no specific bleeding
risk assessment tool to predict bleeding events in STEMI patient.
Methods A retrospective cohort study, done in National Cardiovascular Center
Harapan Kita, Jakarta in STEMI patients underwent Primary Percutaneous
Coronary Intervention (PPCI). Bleeding event was defined according to definition
by Bleeding Academic Research Consortium (BARC) – European Society
of Cardiology, 2011. Categories for data obtained was basic characteristics,
clinical examinations, initial therapies, lab results, x-ray, PPCI procedures, and
in hospital treatments. Statistical analysis was done using multivariat analysis
using logistic regression method and then converted to a scoring system.
Results 579 sampels fit the inclusion and exclusion criteria. Bleeding event
occured in 42 patients (7.3%). Indonesia bleeding score (Range 1-100) was
created by assignment of variables that included in the final model according
to their Odds Ratio (OR) values. Those variables are: female gender
(OR 2.91, CI 1.23-6.91), Killip class 3 / 4 (OR 5.64, CI 2.27-14.03), Age ?
62 y.o (OR 2.19, CI 1.00-4.83), White blood cell >12.000 (OR 2.12, CI
0.95-4.73), Creatinine >1.5 (OR 2.17, CI 0.95-4.96), Body Mass Index ?
25 (OR 1.71, CI 0.83-3.51), Multiple coronary lesion (OR 1.95, CI 0.83-
4.54), Femoral access (OR 2.33, CI 0.77-7.01), and TPM implantation (OR
3.21, CI 1.28-8.07). These variabels was converted into two type of scoring
system. The INA-1 contains all of the variables, and INA-2 minus variables
related to interventional result and procedures.
Conclusion Indonesia bleeding score quantifies risk for in-hospital bleeding
event in STEMI patients underwent PPCI, which enhances baseline risk
assessment for STEMI care.
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References
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JAMA 2007;298:2497-506.
Gitt AK, Towae F, Zahn R, et al. Major Bleeding Complications
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Bleeding in Patients With Acute Coronary Syndromes. Journal
of the American College of Cardiology 2010;55:2556-66.
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experience. Archives of Cardiovascular Diseases Supplements
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with an invasive strategy. Am Heart J 2013;165:583-90
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Steinhubl SR, Kastrati A, Berger PB. Variation in the definitions
of bleeding in clinical trials of patients with acute coronary
syndromes and undergoing percutaneous coronary interventions
and its impact on the apparent safety of antithrombotic drugs.
Am Heart J 2007;154:3-11.
Verheugt FW, Steinhubl SR, Hamon M, et al. Incidence,
prognostic impact, and influence of antithrombotic therapy
on access and nonaccess site bleeding in percutaneous coronary
intervention. JACC Cardiovasc Interv 2011;4:191-7.
X Flores-Ríos DC-M, J Rodríguez-Garrido, M García-
Guimaraes, P Gargallo-Fernández, P Piñón-Esteban. Comparison
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and ACTION bleeding risk scores in STEMI
undergoing primary PCI: insights from a cohort of 1391 patients
European Heart Journal: Acute Cardiovascular Care 2013;2:19-
26.
Rao SV, O’Grady K, Pieper KS, et al. A comparison of the clinical
impact of bleeding measured by two different classifications
among patients with acute coronary syndromes. J Am Coll Cardiol 2006;47:809-16
White HD. The ATOLL trial of enoxaparin in primary percutaneous
coronary intervention. Eur Heart J 2010;31:2826-7.
Giugliano RP, White JA, Bode C, et al. Early versus delayed,
provisional eptifibatide in acute coronary syndromes. N Engl J
Med 2009;360:2176-90.
Lardizabal JA, Joshi BK, Ambrose JA. The balance between antiischemic
efficacy and bleeding risk of antithrombotic therapy
in percutaneous coronary intervention: a Yin-Yang paradigm.
J Invasive Cardiol 2010;22:284-92.
Alexander KP, Chen AY, Newby LK, et al. Sex differences in
major bleeding with glycoprotein IIb/IIIa inhibitors: results
from the CRUSADE (Can Rapid risk stratification of Unstable
angina patients Suppress ADverse outcomes with Early implementation
of the ACC/AHA guidelines) initiative. Circulation
2006;114:1380-7.
Mehran R, Pocock S, Nikolsky E, et al. Impact of bleeding on
mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials. JACC Cardiovasc Interv 2011;4:654-64.
in patients with acute coronary syndromes undergoing early
invasive management: one-year results from the ACUITY trial.
JAMA 2007;298:2497-506.
Gitt AK, Towae F, Zahn R, et al. Major Bleeding Complications
in Patients with Stemi Account for a Doubling in Hospital Mortality
in Clinical Practice: Lessons from the Euro Heart Survey
ACS Registry. Journal of the American College of Cardiology
2010;55:A101.E945-A101.E945.
Moscucci M. Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events
(GRACE). European Heart Journal 2003;24:1815-23.
Subherwal S, Bach RG, Chen AY, 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;119:1873-82.
Mathews R, Peterson ED, Chen AY, 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;107:1136-
43.
Steg PG, Huber K, Andreotti F, et al. Bleeding in acute coronary
syndromes and percutaneous coronary interventions: position
paper by the Working Group on Thrombosis of the European
Society of Cardiology. European Heart Journal 2011;32:1854-
64.
Mehran R, Pocock SJ, Nikolsky E, et al. A Risk Score to Predict
Bleeding in Patients With Acute Coronary Syndromes. Journal
of the American College of Cardiology 2010;55:2556-66.
Barthelemy O JS, Anne Bellemain-Appaix, F. Beygui, J.P. Collet.
Incidence, type and prognostic impact of bleeding complications
with radial primary PCI of STEMI: The Pitié-Salpêtrière
experience. Archives of Cardiovascular Diseases Supplements
2010;2:6.
Klutstein MW, Westerhout CM, Armstrong PW, et al. Radial
versus femoral access, bleeding and ischemic events in patients
with non-ST-segment elevation acute coronary syndrome managed
with an invasive strategy. Am Heart J 2013;165:583-90
e1.
Steinhubl SR, Kastrati A, Berger PB. Variation in the definitions
of bleeding in clinical trials of patients with acute coronary
syndromes and undergoing percutaneous coronary interventions
and its impact on the apparent safety of antithrombotic drugs.
Am Heart J 2007;154:3-11.
Verheugt FW, Steinhubl SR, Hamon M, et al. Incidence,
prognostic impact, and influence of antithrombotic therapy
on access and nonaccess site bleeding in percutaneous coronary
intervention. JACC Cardiovasc Interv 2011;4:191-7.
X Flores-Ríos DC-M, J Rodríguez-Garrido, M García-
Guimaraes, P Gargallo-Fernández, P Piñón-Esteban. Comparison
of the performance of the CRUSADE, ACUITYHORIZONS,
and ACTION bleeding risk scores in STEMI
undergoing primary PCI: insights from a cohort of 1391 patients
European Heart Journal: Acute Cardiovascular Care 2013;2:19-
26.
Rao SV, O’Grady K, Pieper KS, et al. A comparison of the clinical
impact of bleeding measured by two different classifications
among patients with acute coronary syndromes. J Am Coll Cardiol 2006;47:809-16
White HD. The ATOLL trial of enoxaparin in primary percutaneous
coronary intervention. Eur Heart J 2010;31:2826-7.
Giugliano RP, White JA, Bode C, et al. Early versus delayed,
provisional eptifibatide in acute coronary syndromes. N Engl J
Med 2009;360:2176-90.
Lardizabal JA, Joshi BK, Ambrose JA. The balance between antiischemic
efficacy and bleeding risk of antithrombotic therapy
in percutaneous coronary intervention: a Yin-Yang paradigm.
J Invasive Cardiol 2010;22:284-92.
Alexander KP, Chen AY, Newby LK, et al. Sex differences in
major bleeding with glycoprotein IIb/IIIa inhibitors: results
from the CRUSADE (Can Rapid risk stratification of Unstable
angina patients Suppress ADverse outcomes with Early implementation
of the ACC/AHA guidelines) initiative. Circulation
2006;114:1380-7.
Mehran R, Pocock S, Nikolsky E, et al. Impact of bleeding on
mortality after percutaneous coronary intervention results from a patient-level pooled analysis of the REPLACE-2 (randomized evaluation of PCI linking angiomax to reduced clinical events), ACUITY (acute catheterization and urgent intervention triage strategy), and HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trials. JACC Cardiovasc Interv 2011;4:654-64.
Published
2015-03-31
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How to Cite
Widodo, W., Soerianata, S., Joesoef, A., & Harimurti, G. (2015). Bleeding Predictor in ST-Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Infarction: The Indonesian (INA) Bleeding Risk Score. Indonesian Journal of Cardiology, 34(4), 220-30. https://doi.org/10.30701/ijc.v34i4.380
Section
Clinical Research
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