BLEED-Myocardial Infarction Score:Predicting mid-term post-discharge bleeding events

作     者：Sérgio Barra Rui Providência Francisca Caetano Inês Almeida Luís Paiva Paulo Dinis António Leito Marques 

作者机构：Cardiology DepartmentCoimbra's Hospital and University Centre-General Hospital3041-801 S.Martinho do BispoCoimbraPortugal Faculty of MedicineUniversity of Coimbra3046-853 CoimbraPortugal 

出 版 物：《World Journal of Cardiology》 (世界心脏病学杂志（英文版）（电子版）)

年 卷 期：2013年第5卷第6期

页      面：196-206页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Myocardial infarction Bleeding Prediction model Risk stratification 

摘      要：AIM:To derive and validate a score for the prediction of mid-term bleeding events following discharge for myocardial infarction(MI).METHODS:One thousand and fifty patients admitted for MI and followed for 19.9 ± 6.7 mo were assigned to a derivation cohort.A new risk model,called BLEEDMI,was developed for predicting clinically significant bleeding events during follow-up(primary endpoint) and a composite endpoint of significant hemorrhage plus all-cause mortality(secondary endpoint),incorporating the following variables:age,diabetes mellitus,arterial hypertension,smoking habits,blood urea nitrogen,glomerular filtration rate and hemoglobin at admission,history of stroke,bleeding during hospitalization or previous major bleeding,heart failure during hospitalization and anti-thrombotic therapies prescribedat *** BLEED-MI model was tested for calibration,accuracy and discrimination in the derivation sample and in a new,independent,validation cohort comprising 852 patients admitted at a later ***:The BLEED-MI score showed good calibration in both derivation and validation samples(HosmerLemeshow test P value 0.371 and 0.444,respectively) and high accuracy within each individual patient(Brier score 0.061 and 0.067,respectively).Its discriminative performance in predicting the primary outcome was relatively high(c-statistic of 0.753 ± 0.032 in the derivation cohort and 0.718 ± 0.033 in the validation sample).Incidence of primary/secondary endpoints increased progressively with increasing BLEED-MI *** the validation sample,a BLEED-MI score below 2 had a negative predictive value of 98.7%(152/154) for the occurrence of a clinically significant hemorrhagic episode during follow-up and for the composite endpoint of post-discharge hemorrhage plus all-cause *** accurate prediction of bleeding events was shown independently of mortality,as BLEED-MI predicted bleeding with similar efficacy in patients who did not die during follow-up:Area Under the