European Heart Journal Advance Access originally published online on June 15, 2007
European Heart Journal 2007 28(16):1936-1945; doi:10.1093/eurheartj/ehm194
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Development and validation of a prognostic risk score for major bleeding in patients undergoing percutaneous coronary intervention via the femoral approach
1 Cardiovascular Research Foundation, Columbia University Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, NY 10032, USA
2 London School of Hygiene and Tropical Medicine, London, UK
3 Cleveland Clinic Foundation, Cleveland, OH, USA
Received 16 September 2006; revised 5 April 2007; accepted 26 April 2007; online publish-ahead-of-print 15 June 2007.
* Corresponding author. Tel: +1 212 851 9304; fax: +1 212 851 9396. E-mail address: gs2184{at}columbia.edu
See page 1917 for the editorial comment on this article (doi:10.1093/eurheartj/ehm265)
Aims: Major bleeding after percutaneous coronary intervention (PCI) is an independent risk factor for early and late mortality. We developed and validated a risk score predictive of major bleeding after PCI using the femoral approach.
Methods and results: Baseline clinical and procedural variables from two contemporary, multicentre, randomized PCI trials were used for risk score development (the REPLACE-2 trial, n = 6002) and validation (the REPLACE-1 trial, n = 1056). On the basis of the odds ratio, independent risk factors were assigned a weighted integer, the sum of which comprised a total risk score. Seven variables were identified as independent correlates of major bleeding (age >55 years, female gender, estimated glomerular filtration rate <60 mL/min/1.73 m2, pre-existing anaemia, administration of low-molecular-weight heparin within 48 h pre-PCI, use of glycoprotein IIb/IIIa inhibitors, and intraaortic balloon pump use). In the development set, the risk of major bleeding varied from 1.0% in patients without risk factors to 5.4% in high-risk patients. The discriminatory power of this risk model was confirmed in the validation data set (area under the receiver operating curve = 0.62).
Conclusion: A simple risk score of baseline clinical and procedural variables is useful to predict the incidence of major peri-procedural bleeding after contemporary PCI using the femoral approach.
Key Words: Major bleeding • Angioplasty • Risk score
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- Major bleeding after PCI. Where is our crystal ball?
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EHJ 2007 28: 1917-1919.[Extract] [Full Text]
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