eISSN: 1897-4295
ISSN: 1734-9338
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej
Current issue Archive Manuscripts accepted About the journal Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
3/2015
vol. 11
 
Share:
Share:
more
 
 
abstract:
Commentary

Bleeding risk stratification in acute coronary syndromes. Is it still valid in the era of the radial approach?

Giuseppe Andó, Francesco Costa

Postep Kardiol Inter 2015; 11, 3 (41): 170–173
Online publish date: 2015/09/28
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Bleeding is the most common adverse event after percutaneous coronary intervention (PCI). It can occur either as a direct complication of the index procedure or spontaneously during the antithrombotic treatment for secondary prevention. Hemorrhagic complications significantly impact the prognosis independently from their timing and have been associated with a poorer quality of life [1]. In addition, anti-thrombotic therapies are now becoming more potent than in the past, and an increase in hemorrhagic events can easily be anticipated in clinical practice with state-of-the-art drug combinations. International guidelines endorse a careful evaluation of the bleeding risk, in order to lower the risk of the devastating consequences of hemorrhagic events with the simultaneous effort to maintain ischemic protection. However, no specific methodology has ever been standardized to assess bleeding risk in patients undergoing PCI, although several bleeding risk scores [2–8], addressing risk stratification in diverse clinical situations, have gained popularity (Table I). They are based on readily available clinical and laboratory values and could improve clinicians’ ability to standardize bleeding risk assessment. Among these, the CRUSADE score [8] was developed from a large registry, which included 71,277 patients with non-ST segment elevation myocardial infarction (NSTEMI), and is recommended by European guidelines for the bleeding stratification of patients with NSTEMI [9]. The CRUSADE score estimates the risk of in-hospital bleeding irrespective of the initial therapeutic strategy, and also confirms its discriminatory capacity in the subgroup of patients managed invasively with PCI [8]. Similarly, the ACUITY score has been developed to appraise in-hospital bleeding risk in a wider acute coronary syndrome (ACS) patient population [3]. Importantly, this score also takes into account the type of anticoagulant used during PCI (i.e. heparin + glycoprotein IIb/IIIa inhibitors or bivalirudin), considering the protective effect of bivalirudin on peri-procedural bleeding as compared to heparin plus glycoprotein IIb/IIIa inhibitors [3].
In the current issue of Postępy w Kardiologii Interwencyjnej/Advances in Interventional Cardiology, the performance of different bleeding risk scores in the PCI scenario is broadly assessed in a meta-analysis [10]. The authors conclude that the appraised risk scores performed similarly in patients with ACS [10]. This result...


View full text...
references:
Vranckx P, Leonardi S, Tebaldi M, et al. Prospective validation of the Bleeding Academic Research Consortium classification in the all-comer PRODIGY trial. Eur Heart J 2014; 35: 2524-9.
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.
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: 2556-66.
Montalescot G, Salette G, Steg G, et al. Development and validation of a bleeding risk model for patients undergoing elective percutaneous coronary intervention. Int J Cardiol 2011; 150: 79-83.
Mrdovic I, Savic L, Krljanac G, et al. Simple risk algorithm to predict serious bleeding in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: RISK-PCI bleeding score. Circ J 2013; 77: 1719-27.
Nikolsky E, Mehran R, Dangas G, et al. Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach. Eur Heart J 2007; 28: 1936-45.
Rao SV, McCoy LA, Spertus JA, et al. An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry. JACC Cardiovasc Interv 2013; 6: 897-904.
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.
Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32: 2999-3054.
Taha S, D’Ascenzo F, Moretti C, et al. Accuracy of bleeding score for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13759 patients. Postęp Kardiol Inter 2015; in press.
Pandie S, Mehta SR, Cantor WJ, et al. Radial versus femoral access for coronary angiography/intervention in women with acute coronary syndromes: insights from the RIVAL Trial (Radial Vs femorAL access for coronary intervention). JACC Cardiovasc Interv 2015; 8: 505-12.
Ando G, Trio O, de Gregorio C. Transient left ventricular dysfunction in patients with neurovascular events. Acute Card Care 2010; 12: 70-4.
Valgimigli M, Gagnor A, Calabro P, et al. Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 2015; 385: 2465-76.
Ando G, Cortese B, Frigoli E, et al. Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI-MATRIX (acute kidney injury-minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub-study. Catheter Cardiovasc Interv 2015; in press.
Stone GW, Witzenbichler B, Guagliumi G, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med 2008; 358: 2218-30.
Valgimigli M, Ariotti S, Costa F. Duration of dual antiplatelet therapy after drug-eluting stent implantation: will we ever reach a consensus? Eur Heart J 2015; 36: 1219-22.
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: 2155-66.
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.
Valgimigli M, Costa F, Byrne R, et al. Dual antiplatelet therapy duration after coronary stenting in clinical practice: results of an EAPCI survey. EuroIntervention 2015; 11: 68-74.
Costa F, Vranckx P, Leonardi S, et al. Impact of clinical presentation on ischaemic and bleeding outcomes in patients receiving 6- or 24-month duration of dual-antiplatelet therapy after stent implantation: a pre-specified analysis from the PRODIGY (Prolonging Dual-Antiplatelet Treatment After Grading Stent-Induced Intimal Hyperplasia) trial. Eur Heart J 2015; 36: 1242-51.
Yeh RW, Kereiakes DJ, Steg PG, et al. Benefits and risks of extended duration dual antiplatelet therapy after PCI in patients with and without acute myocardial infarction. J Am Coll Cardiol 2015; 65: 2211-21.
Costa F, Adamo M, Ariotti S, et al. Left main or proximal left anterior descending coronary artery disease location identifies high-risk patients deriving potentially greater benefit from prolonged dual antiplatelet therapy duration. EuroIntervention 2015; 11-online publish-ahead-of-print August 2015.
Quick links
© 2019 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe