RESUMEN
BACKGROUND: Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease. METHODS: We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. RESULTS: The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, p = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, p = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all p values >0.3). CONCLUSIONS: The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.
RESUMEN
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Asunto(s)
Humanos , Síndrome Coronario Agudo/complicaciones , Enfermedades Cardiovasculares/epidemiología , Ajuste de Riesgo/métodos , Reproducibilidad de los Resultados , Valor Predictivo de las PruebasAsunto(s)
Síndrome Coronario Agudo/epidemiología , Enfermedades Cardiovasculares/mortalidad , Infarto del Miocardio sin Elevación del ST/epidemiología , Sistema de Registros , Infarto del Miocardio con Elevación del ST/epidemiología , Accidente Cerebrovascular/epidemiología , Síndrome Coronario Agudo/metabolismo , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hemoglobinas/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio sin Elevación del ST/metabolismo , Alta del Paciente , Enfermedades Vasculares Periféricas/epidemiología , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo/métodos , Infarto del Miocardio con Elevación del ST/metabolismo , Factores Sexuales , España/epidemiología , Volumen SistólicoRESUMEN
The aim of this study is to determine mean platelet volume (MPV) in a population with non-ST-elevation acute coronary syndrome (nSTEACS) and explore its relation with prognosis. Patients (n = 329) with a diagnosis of nSTEACS at admission were recruited, with a determination of MPV in the first 12 hours at admission. We also collected blood from 87 healthy controls. A composite end point of cardiovascular death and new ACS was assessed at 6-month follow-up. Patients with nSTEACS showed larger platelets (MPV: 11.0 [10.3-11.8] vs 9.2 [8.6-10.0] fL; P < .001.). In Cox regression analysis, MPV at admission was a significant predictor of cardiovascular adverse events in univariate analysis, hazard ratio (HR) 1.4 95% confidence interval (CI) 1.1-1.8; P = .018; but after adjustment with clinical variables, MPV lost its statistical significance. In conclusion, patients with nSTEACS present with larger platelets than healthy controls, however this parameter did not show an independent prognostic significance at 6-month follow-up.
