Performance of the ATRIA Bleeding Score in Predicting the Risk of In-Hospital Bleeding in Patients with ST-Elevation or Non-ST-Elevation Myocardial Infarction

ABSTRACT 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.

摘要 引言：对于因心肌梗死（myocardial infarction, MI）就诊的患者，出血风险评分的精准评估对预后判断至关重要。心房颤动抗凝与危险因素（ATRIA）评分是经过验证的心房颤动（atrial fibrillation, AF）患者出血风险预测模型，但其在接受抗栓治疗的ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）或非ST段抬高型心肌梗死（non-STEMI, NSTEMI）患者行经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）后出血事件中的预测价值尚不明确。本研究旨在对比ATRIA出血评分与CRUSADE（不稳定型心绞痛患者快速危险分层以早期落实美国心脏病学会/美国心脏协会指南抑制不良结局）评分及ACUITY-HORIZONS（急性导管术与紧急介入治疗分诊策略——急性心肌梗死血运重建与支架置入预后统一）评分，探讨其在STEMI与NSTEMI患者中的预测效能。
方法：本研究回顾性分析了830例连续纳入的接受PCI治疗的STEMI与NSTEMI患者。计算所有患者的ATRIA、CRUSADE及ACUITY-HORIZONS风险评分。采用C统计量评估三种风险模型的区分能力。
结果：830例患者住院期间共发生52例（6.3%）主要出血事件。发生出血的患者其出血评分显著高于未出血患者（所有P<0.001）。ATRIA、CRUSADE及ACUITY-HORIZONS评分对出血事件的区分能力相近，对应的C统计量分别为0.810、0.832及0.909。在NSTEMI亚组与STEMI亚组中，三种评分同样展现出良好的出血风险预测价值，对应的C统计量分别为0.820、0.793、0.921以及0.809、0.854、0.905。
结论：本研究证实，ATRIA出血评分可有效预测MI患者住院期间的主要出血事件，且该良好的预测价值在STEMI与NSTEMI患者亚组中同样成立。