It is well known that the occurrence of bleeding increases in-hospital mortality
in patients with acute coronary syndromes (ACS), and there is a good correlation
between bleeding risk scores and bleeding incidence. However, the role of bleeding
risk score as mortality predictor is poorly studied.
The main purpose of this paper was to analyze the role of bleeding risk score as
in-hospital mortality predictor in a cohort of patients with ACS treated in a
single cardiology tertiary center.
Out of 1,655 patients with ACS (547 with ST-elevation ACS and 1,118 with
non-ST-elevation ACS), we calculated the ACUITY/HORIZONS bleeding score
prospectively in 249 patients and retrospectively in the remaining 1,416.
Mortality information and hemorrhagic complications were also obtained.
Among the mean age of 64.3 ± 12.6 years, the mean bleeding score was 18 ± 7.7. The
correlation between bleeding and mortality was highly significant (p < 0.001,
OR = 5.296), as well as the correlation between bleeding score and in-hospital
bleeding (p < 0.001, OR = 1.058), and between bleeding score and in-hospital
mortality (adjusted OR = 1.121, p < 0.001, area under the ROC curve 0.753, p
< 0.001). The adjusted OR and area under the ROC curve for the population with
ST-elevation ACS were, respectively, 1.046 (p = 0.046) and 0.686 ± 0.040 (p <
0.001); for non-ST-elevation ACS the figures were, respectively, 1.150 (p <
0.001) and 0.769 ± 0.036 (p < 0.001).
Bleeding risk score is a very useful and highly reliable predictor of in-hospital
mortality in a wide range of patients with acute coronary syndromes, especially in
those with unstable angina or non-ST-elevation acute myocardial infarction.