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RESEARCH PRODUCT
Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry.
Javier J. LópezAlbert Ariza-soléJuan SanchisMiquel Vives-borrásOriol AlegreManuel Martínez-sellésFrancesc FormigaVioleta González-salvadoAngel CequierAgnès RafecasEmad Abu-assiMaría T. VidánJordi BañerasHéctor BuenoPablo Díez-villanuevaFrancisco MarínJaime AboalAlessandro SionisRamón López-palopCarme GuerreroPau VilardellCinta Llibresubject
Malemedicine.medical_specialtyFrail ElderlyGerontologíaEnfermedad cardiovascularHemorrhageComorbidityfrailty030204 cardiovascular system & hematologyLogistic regressionRisk Assessmentelderly03 medical and health sciences0302 clinical medicineInternal medicinemedicineHumansValoración geriátricaSíndrome coronario agudoacute coronary syndromes030212 general & internal medicineProspective StudiesRegistriesAcute Coronary SyndromeProspective cohort studyGeriatric AssessmentAgedAged 80 and overInpatientsbiologyReceiver operating characteristicbusiness.industryGeriatric assessmentHematologyOdds ratiomedicine.diseasebleedingComorbidityTroponinTroponincomorbidityArea Under Curvebiology.proteinFemaleRisk assessmentbusinessdescription
Background: Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods: The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results: Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion: Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal. Sin financiación 4.733 JCR (2018) Q1, 15/73 Hematology, 9/65 Peripheral Vascular Disease 2.023 SJR (2018) Q1, 18/135 Hematology No data IDR 2018 UEM
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-01-01 |