Baseline Risk of Major Bleeding in Non-ST-Segment-Elevation Myocardial Infarction The CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Bleeding Score
Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110, USA. Circulation
(Impact Factor: 14.43).
04/2009; 119(14):1873-82. DOI: 10.1161/CIRCULATIONAHA.108.828541
Treatments for non-ST-segment-elevation myocardial infarction (NSTEMI) reduce ischemic events but increase bleeding. Baseline prediction of bleeding risk can complement ischemic risk prediction for optimization of NSTEMI care; however, existing models are not well suited for this purpose.
We developed (n=71 277) and validated (n=17 857) a model that identifies 8 independent baseline predictors of in-hospital major bleeding among community-treated NSTEMI patients enrolled in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) Quality Improvement Initiative. Model performance was tested by c statistics in the derivation and validation cohorts and according to postadmission treatment (ie, invasive and antithrombotic therapy). The CRUSADE bleeding score (range 1 to 100 points) was created by assignment of weighted integers that corresponded to the coefficient of each variable. The rate of major bleeding increased by bleeding risk score quintiles: 3.1% for those at very low risk (score < or = 20); 5.5% for those at low risk (score 21-30); 8.6% for those at moderate risk (score 31-40); 11.9% for those at high risk (score 41-50); and 19.5% for those at very high risk (score >50; P(trend) <0.001). The c statistics for the major bleeding model (derivation=0.72 and validation=0.71) and risk score (derivation=0.71 and validation=0.70) were similar. The c statistics for the model among treatment subgroups were as follows: > or = 2 antithrombotics=0.72; <2 antithrombotics=0.73; invasive approach=0.73; conservative approach=0.68.
The CRUSADE bleeding score quantifies risk for in-hospital major bleeding across all postadmission treatments, which enhances baseline risk assessment for NSTEMI care.
Available from: Vincent Bataille
- "En revanche, l'âge n'apparaît plus comme un facteur important pour la survenue de plusieurs types de complications ; en particulier, il n'y a pas de lien clair avec le risque d'accident vasculaire cérébral. De même, et en contradiction avec des observations antérieures , l'âge n'apparaît pas comme un déterminant essentiel du risque de saignement grave ; il faut sans doute y voir un lien avec l'utilisation fréquente de la voie radiale lors des stratégies invasives (dans le NSTEMI, deux-tiers des patients de 85 ans et 54 % dans le STEMI). "
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ABSTRACT: Le registre FAST-MI 2010 a collecté les caractéristiques et l’évolution clinique des patients hospitalisés pour un infarctus du myocarde dans 213 établissements français publics et privés pendant une période d’un mois à la fin de 2010.
Parmi les 3079 patients inclus, 31 % sont âgés de 75 ans ou plus (25 % des patients ayant un infarctus avec sus-décalage et 38 % de ceux ayant un infarctus sans sus-décalage).
Les patients les plus âgés ont de plus nombreux facteurs de risque, et plus fréquemment des antécédents cardiovasculaires et des pathologies associées.
La douleur thoracique reste le symptôme d’appel le plus commun, mais une part importante s’accompagne de signes d’insuffisance cardiaque.
La prise en charge diffère sensiblement de celle des malades plus jeunes, avec une moindre utilisation des traitements recommandés, et notamment des traitements de reperfusion dans les infarctus avec sus-décalage.
La mortalité hospitalière augment nettement avec l’âge, en particulier après 85 ans, mais elle a nettement reculé par rapport aux enquêtes antérieures.
La Presse Médicale 11/2013; 42(11):1432–1441. DOI:10.1016/j.lpm.2013.04.010 · 1.08 Impact Factor
Available from: PubMed Central
- "We didn't find genders difference for hemorrhagic complications either. The recently reported CRUSADE score we used  has been validated in the NSTEMI setting. This score takes female gender into account as risk marker for bleeding and is online with various reported data. "
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ABSTRACT: To analyze the in-hospital complication rate in women suffering from non-ST elevation myocardial infarction treated with percutaneous coronary intervention (PCI) compared to men.
The files of 479 consecutive patients (133 women and 346 men) suffering from a Non STEMI (Non ST-segment elevation myocardial infarction) between the January 1st 2006 and March 21st 2009 were retrospectively analyzed with special attention to every single complication occurring during hospital stay. Data were analyzed using nonparametric tests and are reported as median unless otherwise specified. A p value < .05 was considered significant.
As compared to men, women were significantly older (75.8 vs. 65.2 years; p < .005). All cardiovascular risk factors but tobacco and hypertension were similar between the groups: men were noticeably more often smoker (p < .0001) and women more hypertensive (p < .005). No difference was noticed for pre-hospital cardiovascular drug treatment. However women were slightly more severe at entry (more Killip class IV; p = .0023; higher GRACE score for in-hospital death - p = .008 and CRUSADE score for bleeding - p < .0001). All the patients underwent PCI of the infarct-related artery after 24 or 48 hrs post admission without sex-related difference either for timing of PCI or primary success rate. During hospitalization, 130 complications were recorded. Though the event rate was slightly higher in women (30% vs. 26% - p = NS), no single event was significantly gender related. The logistic regression identified age and CRP concentration as the only predictive variables in the whole group. After splitting for genders, these parameters were still predictive of events in men. In women however, CRP was the only one with a borderline p value.
Our study does not support any gender difference for in-hospital adverse events in patients treated invasively for an acute coronary syndrome without ST-segment elevation and elevated troponin.
BMC Cardiovascular Disorders 06/2010; 10:31. DOI:10.1186/1471-2261-10-31 · 1.88 Impact Factor
Available from: Martin Guay
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ABSTRACT: We pose and solve an extremum seeking control problem for a class of state-constrained nonlinear systems with unknown parameters. The approach is based on previous work for unconstrained systems, where controllers are derived to drive system states to the set points, which maximize the value of an objective function with unknown parameters. State constraints are handled using an interior-point method. Simulation results demonstrate the effectiveness of the approach.
American Control Conference, 2004. Proceedings of the 2004; 01/2004
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