• NEWS . 26 Aug 2019
  • Combinations of bleeding and ischaemic risk associated with clinical outcomes in patients with acute coronary syndrome

  • One in three patients presenting with acute coronary syndrome (ACS) is at high ischaemic and high bleeding risk, and these patients are more likely to experience poor clinical outcomes. They are also less likely to receive guideline-recommended therapy.

    Researchers in the UK performed a retrospective analysis of 17,701 patients with a confirmed discharge diagnosis of ACS, including non-ST elevation myocardial infarction, ST-elevation myocardial infarction and unstable angina. A combination of risk scores from the Global Registry of Acute Cardiac Events (GRACE) and the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) was used. Patients were stratified into nine groups based on possible CRUSADE-GRACE risk combinations, Group 9 being at ‘dual high risk’ of ischaemia and bleeding risk and Group 1 having ‘dual low risk’ of CRUSADE-GRACE.

    Almost a third of patients with ACS were at ‘dual high risk’ (Group 9, 32%) and were independently associated with higher in-hospital net adverse cardiac events, all-cause mortality, all-cause bleeding and 30-day mortality. This group of patients was also the least likely to be offered coronary angiography and dual antiplatelet therapy. They therefore represent a diagnostic dilemma, since despite being at increased risk of both ischaemic and bleeding events, they are less likely to receive therapies such as dual antiplatelet therapy or an invasive approach.

    Reference:
    Mohamed MO, et al. Combinations of bleeding and ischemic risk and their association with clinical outcomes in acute coronary syndrome. Int J Cardiol 2019;290:7-14.