Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

Albert Ariza-Solé, Carme Guerrero, Francesc Formiga, Jaime Aboal, Emad Abu-Assi, Francisco Marín, Héctor Bueno, Oriol Alegre, Ramón López-Palop, María T. Vidán, Manuel Martínez-Sellés, Pablo Díez-Villanueva, Pau Vilardell, Alessandro Sionis, Miquel Vives-Borrás, Juan Sanchís, Jordi Bañeras, Agnès Rafecas, Cinta Llibre, Javier LópezVioleta González-Salvado, Àngel Cequier

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    Abstract

    © 2018 Schattauer. Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton-Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.
    Original languageEnglish
    Pages (from-to)581-590
    JournalThrombosis and Haemostasis
    Volume118
    Issue number3
    DOIs
    Publication statusPublished - 1 Mar 2018

    Keywords

    • acute coronary syndromes
    • bleeding
    • comorbidity
    • elderly
    • frailty

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    Ariza-Solé, A., Guerrero, C., Formiga, F., Aboal, J., Abu-Assi, E., Marín, F., Bueno, H., Alegre, O., López-Palop, R., Vidán, M. T., Martínez-Sellés, M., Díez-Villanueva, P., Vilardell, P., Sionis, A., Vives-Borrás, M., Sanchís, J., Bañeras, J., Rafecas, A., Llibre, C., ... Cequier, À. (2018). Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry. Thrombosis and Haemostasis, 118(3), 581-590. https://doi.org/10.1055/s-0038-1623532