Evaluation of Bleeding Risk in Patients with Acute Myocardial Infarction Undergoing Transradial Percutaneous Coronary Intervention

Abstract

We investigated the accuracy of various bleeding risk scores to estimate the bleeding risk in patients with acute myocardial infarction (AMI) managed with percutaneous coronary intervention (PCI) access via the radial artery. We retrospectively enrolled 1,651 patients who were definitively diagnosed with ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI). We assessed the predictive validities of 30-day bleeding events in various scoring systems using receiver operating characteristic curves. Overall, ACUITY-HORIZONS exhibited the highest area under the curve to predict 30-day bleeding, followed by ACTION and CRUSADE; HAS-BLED displayed the lowest score. With a cutoff of 17, ACUITY-HORIZONS demonstrated the best discrimination for the Thrombolysis in Myocardial Infarction (TIMI) 30-day serious bleeding rate. We observed significant differences among all-cause death, cardiovascular death, and major adverse cardiac events between the ACUITY-HORIZONS groups with a score of !17 and > 17. ACUITY-HORIZONS score > 17, initial systolic blood pressure (SBP) < 90 mmHg, and Killip III and IV upon admission positively predicted the 30-day bleeding risk, whereas myocardial infarction (MI) and TIMI major bleeding within 30 days, heart failure at admission, and initial SBP < 90 mmHg positively predicted the 30-day mortality. Comparatively, ACUITY-HORIZON is the most reliable system in predicting 30-day bleeding for patients with AMI via transradial PCI. In the transradial scenario, bleeding and MI within 30 days are substantially related to 30-day mortality.

Clinical significance of bleeding scoring systems

“…Patients with acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) frequently experience bleeding events (from gastrointestinal to intracranial) which have a significant contribution to the morbidity and mortality of these patients [3,28].…”

“…These bleeding events could be justified by the fact that these patients are usually older people who are prone to bleeding events, that they often have comorbidities that precipitate the occurrence of bleeding (unregulated hypertension, stress ulcers...), or that they use drugs that potentiate the occurrence of bleeding events (antiplatelet drugs, NSAID...) [3,18].…”

“…Since the transradial (TR) approach in performing a PCI is associated with a lower incidence of bleeding events in comparison to the transfemoral approach, by favoring the TR approach, it is possible to reduce the rate of bleeding events in patients with AMI treated with PCI [3,29].…”

“…Here we will mention CRUSADE, ACTION, and ACUITY-HORIZONS scoring systems which are used for the assessment of bleeding risk in patients with AMI treated with a PCI [3].…”

“…There are various primary outcomes, such as the risk of bleeding occurrence, risk of rebleeding, bleeding mortality risk, or the need for therapeutic intervention, depending on the BSS used [2,3].…”