PMID- 32586729
OWN - NLM
STAT- MEDLINE
DCOM- 20210512
LR  - 20210512
IS  - 1444-2892 (Electronic)
IS  - 1443-9506 (Linking)
VI  - 29
IP  - 12
DP  - 2020 Dec
TI  - Meta-Analysis of Bleeding Scores Performance for Acute Coronary Syndrome.
PG  - 1749-1757
LID - S1443-9506(20)30233-X [pii]
LID - 10.1016/j.hlc.2020.04.008 [doi]
AB  - BACKGROUND: Bleeding is a common and frequently devastating complication in acute 
      coronary syndrome (ACS). It is critical to evaluate in the current era of ACS 
      management involving invasive strategies and potent anti-thrombotics. Risk models 
      remain under-utilised in this setting but may guide the choice and duration of 
      therapy. We compared their performances for predicting bleeding in ACS patients 
      in this meta-analysis. METHODS: Medline, EMBASE, Cochrane and Scopus were 
      searched for relevant articles from 1980 to 31 December 2017 assessing external 
      validation of risk scores for bleeding after ACS. Two (2) authors independently 
      reviewed the searched studies for eligibility, followed by pooled analyses using 
      random effects models. RESULTS: Amongst 1,843 articles searched, 73 full-texts 
      were reviewed and 17 studies totalling 18,155 patients were included for 
      analysis. C-statistics (95% confidence interval) for predicting in-hospital major 
      bleeding by risk model were Can Rapid risk stratification of Unstable angina 
      patients Suppress ADverse outcomes with Early implementation of the ACC/AHA 
      guidelines (CRUSADE) 0.714 (0.659-0.779), Acute Catheterization and Urgent 
      Intervention Triage strategY (ACUITY) 0.711 (0.626-0.797), Acute Coronary 
      Treatment and Intervention Outcomes Network (ACTION) 0.767 (0.737-0.797), Global 
      Registry of Acute Coronary Events (GRACE) 0.689 (0.473-0.905) and HAS-BLED 0.636 
      (0.460-0.812). CRUSADE also predicted bleeding during medium-term follow-up 
      c=0.704 (0.644-0.765). It performed better for radial versus femoral access 
      (c=0.826 and 0.734), invasive versus non-invasive strategy (c=0.752 and 0.625) 
      and similarly for ST elevation myocardial infarction (STEMI) and non-ST elevation 
      myocardial infarction (NSTEMI) (c=0.791 and 0.760). Heterogeneities of studies 
      and paucity of studies assessing risk scores beyond CRUSADE were important 
      limitations. CONCLUSIONS: Acute coronary syndrome-specific bleeding scores had 
      moderate discrimination for bleeding, while the GRACE and HAS-BLED scores could 
      not. The ACTION score had the highest pooled c-statistic, while the CRUSADE score 
      was the most widely studied, and also performed better for invasive strategy and 
      radial access subgroups.
CI  - Copyright (c) 2020 Australian and New Zealand Society of Cardiac and Thoracic 
      Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). 
      Published by Elsevier B.V. All rights reserved.
FAU - Wang, Tom Kai Ming
AU  - Wang TKM
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; 
      Department of Medicine, University of Auckland, Auckland, New Zealand. Electronic 
      address: TWang@adhb.govt.nz.
FAU - Mehta, Ojas Hrakesh
AU  - Mehta OH
AD  - Department of Cardiology, Royal Melbourne Hospital, Melbourne, Vic, Australia.
FAU - Liao, Yi-Wen Becky
AU  - Liao YB
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
FAU - Wang, Michael Tzu Min
AU  - Wang MTM
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; 
      Department of Medicine, University of Auckland, Auckland, New Zealand.
FAU - Stewart, Ralph
AU  - Stewart R
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; 
      Department of Medicine, University of Auckland, Auckland, New Zealand.
FAU - White, Harvey
AU  - White H
AD  - Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; 
      Department of Medicine, University of Auckland, Auckland, New Zealand.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20200609
PL  - Australia
TA  - Heart Lung Circ
JT  - Heart, lung & circulation
JID - 100963739
SB  - IM
MH  - Acute Coronary Syndrome/*complications
MH  - Hemorrhage/*diagnosis/etiology
MH  - Humans
MH  - *Registries
MH  - Risk Assessment/*methods
OTO - NOTNLM
OT  - Acute coronary syndrome
OT  - Bleeding
OT  - Myocardial infarction
OT  - Risk models
EDAT- 2020/06/27 06:00
MHDA- 2021/05/13 06:00
CRDT- 2020/06/27 06:00
PHST- 2018/11/19 00:00 [received]
PHST- 2020/03/12 00:00 [revised]
PHST- 2020/04/16 00:00 [accepted]
PHST- 2020/06/27 06:00 [pubmed]
PHST- 2021/05/13 06:00 [medline]
PHST- 2020/06/27 06:00 [entrez]
AID - S1443-9506(20)30233-X [pii]
AID - 10.1016/j.hlc.2020.04.008 [doi]
PST - ppublish
SO  - Heart Lung Circ. 2020 Dec;29(12):1749-1757. doi: 10.1016/j.hlc.2020.04.008. Epub 
      2020 Jun 9.