Mathews et al reported a model for predicting major bleeding during in-hospital management of an acute myocardial infarction. The authors are from Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry Get with the Guidelines (GWTG).
Patient selection: ST-elevation and non-ST-elevation acute myocardial infarction
Parameters:
(1) age in years
(2) baseline serum creatinine in mg/dL
(3) systolic blood pressure on admission in mm Hg
(4) baseline hemoglobin in g/dL
(5) heart rate on admission in beats per minute
(6) weight in kilograms
(7) gender
(8) home warfarin use
(9) diabetes mellitus
(10) heart failure on admission
(11) ECG changes
(12) previous peripheral arterial disease
|
Parameters |
Findings |
Points |
|
age in years |
<= 40 years |
0 |
|
|
41 to 50 |
1 |
|
|
51 to 60 |
2 |
|
|
61 to 70 |
3 |
|
|
71 to 80 |
4 |
|
|
81 to 90 |
5 |
|
|
>= 91 |
6 |
|
serum creatinine |
< 0.8 |
0 |
|
|
0.8 to 1.59 |
1 |
|
|
1.6 to 1.99 |
2 |
|
|
2.0 to 2.99 |
4 |
|
|
3.0 to 3.99 |
6 |
|
|
4.0 to 4.99 |
8 |
|
|
5.0 to 5.99 |
10 |
|
|
>= 6 |
11 |
|
|
on dialysis |
11 |
|
systolic blood pressure |
<= 90 |
4 |
|
|
91 to 100 |
3 |
|
|
101 to 120 |
2 |
|
|
121 to 140 |
1 |
|
|
141 to 170 |
0 |
|
|
171 to 200 |
1 |
|
|
>= 201 |
2 |
|
hemoglobin |
< 5 |
17 |
|
|
5 to 7.9 |
15 |
|
|
8 to 9.9 |
13 |
|
|
10 to 10.9 |
12 |
|
|
11 to 13.9 |
9 |
|
|
14 to 15.9 |
6 |
|
|
>= 16 |
2 |
|
heart rate |
<= 40 |
0 |
|
|
41 to 60 |
2 |
|
|
61 to 70 |
3 |
|
|
71 to 80 |
5 |
|
|
81 to 100 |
6 |
|
|
101 to 110 |
8 |
|
|
111 to 120 |
9 |
|
|
121 to 130 |
11 |
|
|
131 to 150 |
12 |
|
|
>= 151 |
14 |
|
weight |
<= 50 |
5 |
|
|
51 to 70 |
4 |
|
|
71 to 100 |
3 |
|
|
101 to 120 |
2 |
|
|
121 to 140 |
1 |
|
|
>= 141 |
0 |
|
gender |
female |
4 |
|
|
male |
0 |
|
home warfarin use |
no |
0 |
|
|
yes |
2 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
3 |
|
heart failure |
none |
0 |
|
|
present |
3 |
|
|
present with shock |
15 |
|
ECG changes |
no ST segment changes |
0 |
|
|
ST depression or transient elevation |
3 |
|
|
ST segment elevation |
7 |
|
previous PAD |
no |
0 |
|
|
yes |
3 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 91
• The higher the score the greater the risk of major in-hospital bleeding.
X =
= (0.08344 * (score)) - 4.771
probability of major bleeding =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.73 in the derivation cohort.
Specialty: Hematology Oncology, Cardiology
