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https://doi.org/10.14300/mnnc.2020.15110

Bleeding rate and diagnostic value of different hemorrhagic risk scores in certain clinical groups of patients with acute coronary syndrome

[Original research]
Victoria Brazhnik; Larisa Minushkina; Niyaz Hasanov; Elena Kosmacheva; Marina Chichkova; Olga Boeva; Elena Karmanchikova; Dmitry Zateyschikov;

The aim of this study was to study the diagnostic value of different scales for assessing the risk of bleeding in patients after an episode of acute coronary syndrome (ACS) in different clinical groups. The study based on data of 1803 patients included in the Russian observational study ORACLE II. 1120 (62.1 %) were men, the mean age was 64.9±12.78 years, 682 (37.8 %) patients had ST-segment elevation ACS. 1584 (87.9 %) patients had hypertension, 410 (22.7 %) patients – diabetes mellitus, 99 patients had aortic valve stenosis, in 465 – GFR was below 60 ml/min/1.73 cm2. Percutaneous coronary intervention (PCI) in connection with this episode of ACS was performed in 924 patients. During the one-year follow-up, bleeding occurred in 177 patients, including 65 significant and 24 major ones. The incidence of major and significant bleeding increased with age and with impaired renal function. In patients who received PCI, the incidence of significant, but not major, bleeding was higher. The diagnostic value of all verified risk scores except the ORACLE score was low in people over 75 years old. The significance of the ORACLE risk score for predicting the risk of bleeding in this group was significantly higher than that of the CRUSADE risk score (AUC 0.706 [0.653–0.755] and 0.509 [0.438–0.580], p<0.05). The ORACLE risk score had advantages over the CRUSADE scale in patients with diabetes mellitus (AUC 0.803 [0.749–0.850] and 0.600 [0.524–0.673], p<0.05) and in patients with impaired renal function (AUC 0.693 [0.644–0.739] and 0.510 [0.443–0.577], p<0.05). Thus, in some clinical groups (older age, diabetes mellitus or reduced kidney function), the diagnostic value of standard risk assessment scales may decrease. The ORACLE risk score, developed and validated in the routine clinical practice of our country, is a universal tool suitable for use in all categories of ACS patients.

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Keywords: acute coronary syndrome, bleeding, risk scale, age, diabetes mellitus, renal function