PMID- 20299114
OWN - NLM
STAT- MEDLINE
DCOM- 20120809
LR  - 20191210
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 150
IP  - 1
DP  - 2011 Jul 1
TI  - Development and validation of a bleeding risk model for patients undergoing 
      elective percutaneous coronary intervention.
PG  - 79-83
LID - 10.1016/j.ijcard.2010.02.077 [doi]
AB  - BACKGROUND: Accurate estimation of bleeding risk in patients undergoing elective 
      percutaneous coronary intervention (PCI) is difficult and not based on widely 
      accepted scores or characteristics. We developed and validated a simple 
      prediction model for major bleeding using the SafeTy and Efficacy of Enoxaparin 
      in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial, which 
      demonstrated the superior safety of enoxaparin over unfractionated heparin (UFH) 
      in 3528 patients undergoing elective PCI. METHODS AND RESULTS: Independent 
      predictors of non-coronary artery bypass graft (CABG)-related major bleeding 
      events were determined using stepwise multivariate logistic regression analysis 
      from a development dataset using bootstrap resampling. These predictors were 
      assigned an integer coefficient (risk score) proportional to the estimated 
      coefficient from the logistic model. Risk scores were tested in a validation 
      cohort. Female sex, use of unfractionated heparin (vs. enoxaparin), and use of a 
      glycoprotein IIb/IIIa inhibitor (vs. nonuse) were the strongest independent 
      predictors of bleeding. Extensive testing found that the final model performed 
      well with bootstrap resampling in the development set (c-statistic 0.75; 95% CI: 
      0.70-0.82; Hosmer-Lemeshow p = 0.29), validation set (c-statistic 0.67; 
      Hosmer-Lemeshow p = 0.12), and subgroups of high-risk patients analysed from the 
      validation set (c-statistic >/= 0.67). CONCLUSIONS: Our model for evaluating the 
      risk of non-CABG-related major bleeding in patients undergoing elective PCI 
      identified sex, the type of antithrombin used, and glycoprotein IIb/IIIa 
      inhibitor use as important indicators of bleeding risk, and accurately predicted 
      the incidence of non-CABG-related major bleeding in patients undergoing elective 
      PCI in the STEEPLE trial.
CI  - Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
FAU - Montalescot, Gilles
AU  - Montalescot G
AD  - Institut de Cardiologie, AP-HP, and INSERM Unit #856, Centre Hospitalier 
      Universitaire Pitie-Salpetriere, Paris, France. gilles.montalescot@psl.aphp.fr
FAU - Salette, Genevieve
AU  - Salette G
FAU - Steg, Gabriel
AU  - Steg G
FAU - Cohen, Marc
AU  - Cohen M
FAU - White, Harvey D
AU  - White HD
FAU - Gallo, Richard
AU  - Gallo R
FAU - Steinhubl, Steven R
AU  - Steinhubl SR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PT  - Validation Study
DEP - 20100317
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Angioplasty, Balloon, Coronary/*adverse effects
MH  - Cohort Studies
MH  - Elective Surgical Procedures/*adverse effects
MH  - Female
MH  - Hemorrhage/diagnosis/epidemiology/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Postoperative Hemorrhage/*diagnosis/epidemiology/etiology
MH  - Prospective Studies
MH  - Risk Factors
EDAT- 2010/03/20 06:00
MHDA- 2012/08/10 06:00
CRDT- 2010/03/20 06:00
PHST- 2009/11/24 00:00 [received]
PHST- 2010/02/13 00:00 [accepted]
PHST- 2010/03/20 06:00 [entrez]
PHST- 2010/03/20 06:00 [pubmed]
PHST- 2012/08/10 06:00 [medline]
AID - S0167-5273(10)00158-0 [pii]
AID - 10.1016/j.ijcard.2010.02.077 [doi]
PST - ppublish
SO  - Int J Cardiol. 2011 Jul 1;150(1):79-83. doi: 10.1016/j.ijcard.2010.02.077. Epub 
      2010 Mar 17.