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Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE)
Quantitative Health Sciences Publications and Presentations
  • Mauro Moscucci, University of Michigan
  • Keith A. A. Fox, University of Edinburgh
  • Christopher P. Cannon
  • Werner Klein
  • José López-Sendón, Hospital Universitario Gregorio Marañon
  • Gilles Montalescot, Centre Hospitalier Universitaire Pitié-Salpêtrière
  • Kami White, University of Massachusetts Medical School
  • Robert J. Goldberg, University of Massachusetts Medical School
UMMS Affiliation
Department of Medicine, Division of Cardiovascular Medicine; Center for Outcomes Research, Department of Surgery
Publication Date
Document Type
Adult; Age Factors; Aged; Aged, 80 and over; Female; Hemorrhage; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Registries; Regression Analysis; Risk Factors; World Health
AIMS: There have been no large observational studies attempting to identify predictors of major bleeding in patients with acute coronary syndromes (ACS), particularly from a multinational perspective. The objective of our study was thus to develop a prediction rule for the identification of patients with ACS at higher risk of major bleeding. METHODS AND RESULTS: Data from 24045 patients from the Global Registry of Acute Coronary Events (GRACE) were analysed. Factors associated with major bleeding were identified using logistic regression analysis. Predictive models were developed for the overall patient population and for subgroups of patients with ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina. The overall incidence of major bleeding was 3.9% (4.8% in patients with STEMI, 4.7% in patients with NSTEMI and 2.3% in patients with unstable angina). Advanced age, female sex, history of bleeding, and renal insufficiency were independently associated with a higher risk of bleeding (P<0.01). The association remained after adjustment for hospital therapies and performance of invasive procedures. After adjustment for a variety of potential confounders, major bleeding was significantly associated with an increased risk of hospital death (adjusted odds ratio 1.64, 95% confidence interval 1.18, 2.28). CONCLUSIONS: In routine clinical practice, major bleeding is a relatively frequent non-cardiac complication of contemporary therapy for ACS and it is associated with a poor hospital prognosis. Simple baseline demographic and clinical characteristics identify patients at increased risk of major bleeding.
Eur Heart J. 2003 Oct;24(20):1815-23.
PubMed ID
Related Resources
Link to Article in PubMed
Citation Information
Mauro Moscucci, Keith A. A. Fox, Christopher P. Cannon, Werner Klein, et al.. "Predictors of major bleeding in acute coronary syndromes: the Global Registry of Acute Coronary Events (GRACE)" Vol. 24 Iss. 20 (2003) ISSN: 0195-668X (Linking)
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