Key result
ATRIA score matches CRUSADE for predicting in-hospital major bleeding after MI, achieving ~0.81 C-statistic.
Why the study?
The predictive value of the ATRIA bleeding score after PCI in STEMI or NSTEMI patients receiving antithrombotic therapy was unknown.
Does the ATRIA bleeding score accurately predict in-hospital major bleeding in STEMI and NSTEMI patients undergoing PCI compared to the CRUSADE and ACUITY-HORIZONS scores?
Observational (n=830)
No
Does the ATRIA bleeding score accurately predict in-hospital major bleeding in STEMI and NSTEMI patients undergoing PCI compared to the CRUSADE and ACUITY-HORIZONS scores?
The ATRIA bleeding score is a simple and useful tool with good predictive value for in-hospital major bleeding in patients with STEMI and NSTEMI undergoing PCI, performing similarly to the more complex CRUSADE score.
ATRIA may aid in-hospital bleeding prediction in MI-PCI patients; extends AF validation but leaves open prospective confirmation before practice change.
INTRODUCTION: A clear assessment of the bleeding risk score in patients presenting with myocardial infarction (MI) is crucial because of its impact on prognosis. The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA score is a validated risk score to predict bleeding risk in atrial fibrillation (AF), but its predictive value in predicting bleeding after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) patients receiving antithrombotic therapy is unknown. Our aim was to investigate the predictive performance of the ATRIA bleeding score in STEMI and NSTEMI patients in comparison to the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the American College of Cardiology/American Heart Association Guidelines) and ACUITY-HORIZONS (Acute Catheterization and Urgent Intervention Triage strategY-Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) bleeding scores. METHODS: A total of 830 consecutive STEMI and NSTEMI patients who underwent PCI were evaluated retrospectively. The ATRIA, CRUSADE, and ACUITY-HORIZONS risk scores of the patients were calculated. Discrimination of the three risk models was evaluated using C-statistics. RESULTS: Major bleeding occurred in 52 (6.3%) of 830 patients during hospitalization. Bleeding scores were significantly higher in the bleeding patients than in non-bleeding patients (all P<0.001). The discriminatory ability of the ATRIA, CRUSADE, and ACUITY-HORIZONS bleeding scores for bleeding events was similar (C-statistics 0.810, 0.832, and 0.909, respectively). The good predictive value of all three scores for predicting the risk of bleeding was observed in NSTEMI and STEMI patients as well (C-statistics: 0.820, 0.793, and 0.921 and 0.809, 0.854, and 0.905, respectively). CONCLUSION: This study demonstrated that the ATRIA bleeding score is a useful risk score for predicting major in-hospital bleeding in MI patients. This good predictive value was also present in STEMI and NSTEMI patient subgroups.
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Yavuz et al. (2022) conducted an observational in ST-Elevation or Non-ST-Elevation Myocardial Infarction (n=830). ATRIA bleeding score vs. CRUSADE and ACUITY-HORIZONS bleeding scores was evaluated on Discriminatory ability (C-statistic) for major bleeding events (BARC type 3 or 5) during hospitalization (C-statistic 0.810, 95% CI 0.745-0.876). The ATRIA bleeding score demonstrated good discriminatory ability for predicting in-hospital major bleeding in patients with myocardial infarction (C-statistic 0.810), performing similarly to the CRUSADE score.
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