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    Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE)

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    Authors
    Moscucci, Mauro
    Fox, Keith A. A.
    Cannon, Christopher P.
    Klein, Werner
    López-Sendón, José
    Montalescot, Gilles
    White, Kami
    Goldberg, Robert J.
    UMass Chan Affiliations
    Center for Outcomes Research, Department of Surgery
    Department of Medicine, Division of Cardiovascular Medicine
    Document Type
    Journal Article
    Publication Date
    2003-10-18
    Keywords
    Adult
    Age Factors
    Aged
    Aged, 80 and over
    Female
    Hemorrhage
    Hospital Mortality
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    Registries
    Regression Analysis
    Risk Factors
    World Health
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1016/S0195-668X(03)00485-8
    Abstract
    AIMS: There have been no large observational studies attempting to identify predictors of major bleeding in patients with acute coronary syndromes (ACS), particularly from a multinational perspective. The objective of our study was thus to develop a prediction rule for the identification of patients with ACS at higher risk of major bleeding. METHODS AND RESULTS: Data from 24045 patients from the Global Registry of Acute Coronary Events (GRACE) were analysed. Factors associated with major bleeding were identified using logistic regression analysis. Predictive models were developed for the overall patient population and for subgroups of patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The overall incidence of major bleeding was 3.9% (4.8% in patients with STEMI, 4.7% in patients with NSTEMI and 2.3% in patients with unstable angina). Advanced age, female sex, history of bleeding, and renal insufficiency were independently associated with a higher risk of bleeding (P<0.01). The association remained after adjustment for hospital therapies and performance of invasive procedures. After adjustment for a variety of potential confounders, major bleeding was significantly associated with an increased risk of hospital death (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.28). CONCLUSIONS: In routine clinical practice, major bleeding is a relatively frequent non-cardiac complication of contemporary therapy for ACS and it is associated with a poor hospital prognosis. Simple baseline demographic and clinical characteristics identify patients at increased risk of major bleeding.
    Source
    Eur Heart J. 2003 Oct;24(20):1815-23.
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47168
    PubMed ID
    14563340
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    Population and Quantitative Health Sciences Publications

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