Key result
The TIMI bleeding classification identified major bleeding in 8.9% of STEMI patients compared to 17.2% with ACUITY, and was more capable of identifying patients at higher risk for early mortality.
Why the study?
Does the TIMI bleeding classification better identify STEMI patients at higher risk for early mortality compared to the ACUITY classification?
Cohort (n=991)
No
Does the TIMI bleeding classification better identify STEMI patients at higher risk for early mortality compared to the ACUITY classification?
In STEMI patients undergoing primary PCI, the TIMI bleeding classification is superior to the ACUITY classification for identifying major bleeding associated with early mortality.
TIMI may better stratify mortality risk in STEMI bleeding; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: In patients with acute coronary syndromes, an increase in hemorrhagic complications has been observed, and bleeding is now the most frequent noncardiac complication in these patients. Clinical trials and registries have used different scales to classify the severity of bleeding; so far, none of them has been developed for ST-segment elevation myocardial infarction (STEMI) patients in the era of primary percutaneous coronary intervention. METHODS: We analyzed data from our Intensive Cardiac Care Florence STEMI Registry, comprising 991 STEMI patients consecutively admitted to our intensive cardiac care unit after mechanical revascularization, to assess the clinical impact of both Thrombolysis In Myocardial Infarction (TIMI) and Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) classifications in identifying patients with major bleeding at higher risk for in-hospital mortality. RESULTS: Major bleeding events occurred in 8.9% of patients (88/991) in the TIMI classification and in 17.2% of patients (170/991) in the ACUITY classification. Among patients with major bleeding classified according to ACUITY, 82 patients did not meet the TIMI criteria for major bleeding. These patients represent the so-called gray zone, where no transfusion was performed and only 1 patient died. CONCLUSIONS: In STEMI patients who undergo primary percutaneous coronary intervention and receive dual antiplatelet therapy, TIMI is more capable than ACUITY in identifying patients with major bleeding at higher risk for early mortality. The presence of renal failure represents an independent predictor for major bleeding.
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Valente et al. (2011) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=991). TIMI bleeding classification vs. ACUITY bleeding classification was evaluated on Major bleeding events. The TIMI bleeding classification identified major bleeding in 8.9% of STEMI patients compared to 17.2% with ACUITY, and was more capable of identifying patients at higher risk for early mortality.
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