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Development and Val...
Development and Validation of a Novel Risk Score for In-Hospital Major Bleeding in Acute Myocardial Infarction : The SWEDEHEART Score
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- Simonsson, Moa (författare)
- Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden
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- Winell, Henric (författare)
- Karolinska Institutet,Uppsala universitet,Statistiska institutionen,Karolinska Inst, Dept Med Epidemiol & Biostat, Solna, Sweden,Karolinska Inst, Sweden; Uppsala Univ, Sweden
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- Olsson, Henrik (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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- Szummer, Karolina (författare)
- Karolinska Institutet,Karolinska Univ Hosp, Sweden; Karolinska Inst, Sweden
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- Alfredsson, Joakim (författare)
- Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
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- Hall, Marlous (författare)
- Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England
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- Dondo, Tatendashe B. (författare)
- Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England
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- Gale, Chris P. (författare)
- Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds, W Yorkshire, England
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- Jernberg, Tomas (författare)
- Karolinska Institutet,Karolinska Inst, Sweden
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(creator_code:org_t)
- WILEY, 2019
- 2019
- Engelska.
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Ingår i: Journal of the American Heart Association. - : WILEY. - 2047-9980. ; 8:5
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://liu.diva-por... (primary) (Raw object)
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https://urn.kb.se/re...
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https://doi.org/10.1...
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http://kipublication...
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https://urn.kb.se/re...
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Abstract
Ämnesord
Stäng
- Background – Bleeding risk stratification in acute coronary syndrome is of highest clinical interest but current risk scores have limitations. We sought to develop and validate a new in-hospital bleeding risk score for patients with acute myocardial infarction.Methods and Results – From the nationwide SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register, 97,597 patients with acute myocardial infarction enrolled from 2009 until 2014 were selected. A full model with 23 predictor variables and 8 interaction terms was fitted using logistic regression. The full model was approximated by a model with 5 predictors and 1 interaction term. Calibration, discrimination, and clinical utility was evaluated and compared with the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) and CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) scores. Internal and temporal validity was assessed. In-hospital major bleeding, defined as fatal, intracranial, or requiring surgery or blood transfusion, occurred in 1356 patients (1.4%). The 5 predictors in the approximate model that constituted the SWEDEHEART score were hemoglobin, age, sex, creatinine, and Creactive protein. The ACTION and CRUSADE scores were poorly calibrated in the derivation cohort and therefore were recalibrated. The SWEDEHEART score showed higher discriminative ability than both recalibrated scores, overall (C-index 0.80 versus 0.73/0.72) and in all predefined subgroups. Decision curve analysis demonstrated consistently positive and higher net benefit for the SWEDEHEART score compared with both recalibrated scores across all clinically relevant decision thresholds. The original ACTION and CRUSADE scores showed negative net benefit.Conclusions – The 5-item SWEDEHEART score discriminates in-hospital major bleeding in patients with acute myocardial infarction and has superior model performance compared with the recalibrated ACTION and CRUSADE scores.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- acute myocardial infarction
- bleeding
- registry
- risk score
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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