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Bleeding Risk Scores and Scales of Frailty for the Prediction of Haemorrhagic Events in Older Adults with Acute Coronary Syndrome: Insights from the FRASER study

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Abstract

Purpose

Hitherto, no study has yielded important information on whether the scales of frailty may improve the ability to discriminate the risk of haemorrhages in older adults admitted to hospital for acute coronary syndrome (ACS). The aim of this study is to investigate whether frailty scales would predict the 1-year occurrence of haemorrhagic events and if they confer a significant incremental prognostic value over the bleeding risk scores.

Methods

The present study involved 346 ACS patients aged ≥ 70 years enrolled in the FRASER study. Seven different scales of frailty and PARIS, PRECISE-DAPT and BleeMACS bleeding risk scores were available for each patient. The outcomes were the 1-year BARC 3-5 and 2 bleeding events.

Results

Adherence to antiplatelet treatment at 1, 6 and 12 months was 98%, 87% and 78%, respectively. At 1-year, 14 (4%) and 30 (9%) patients presented BARC 3-5 and 2 bleedings, respectively. Bleeding risk scores and four scales of frailty (namely Short Physical Performance Battery, Columbia, Edmonton and Clinical Frailty Scale) significantly discriminated the occurrence of BARC 3-5 events. The addition of the scales of frailty to bleeding risk scores did not lead to a significant improvement in the ability to predict BARC 3-5 bleedings. Neither the bleeding risk scores nor the scales of frailty predicted BARC 2 bleedings.

Conclusions

Both the bleeding risk scores and the scales of frailty predicted BARC 3-5 haemorrhages. However, integrating the scales of frailty with the bleeding risk scores did not improve their discriminative ability.

Clinical trial registration

www.clinicaltrials.gov: NCT02386124

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Abbreviations

ACS:

Acute coronary syndrome

DAPT:

Dual antiplatelet therapy

FRASER:

Frailty in elderly patients receiving cardiac interventional procedures

BARC:

Bleeding Academic Research Consortium

PRECISE-DAPT:

Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy

PARIS:

Patterns of Non-adherence to Anti-platelet Regimen in Stented Patients

BleeMACS:

Bleeding complications in a multicentre registry of patients discharged with diagnosis of acute coronary syndrome

SPPB:

Short Physical Performance Battery

CFS:

Clinical Frailty Scale

References

  1. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39:213–60.

    Article  Google Scholar 

  2. Alonso Salinas GL, Sanmartin M, Pascual Izco M, et al. The role of frailty in acute coronary syndromes in the elderly. Gerontology. 2018:1–8.

  3. Costa F, Tijssen JG, Ariotti S, et al. Incremental Value of the CRUSADE, ACUITY, and HAS-BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy. J Am Heart Assoc. 2015;4(12).

  4. Raposeiras-Roubín S, Faxén J, Íñiguez-Romo A, Henriques JPS, D'Ascenzo F, Saucedo J, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: the BleeMACS score. Int J Cardiol. 2018;254:10–5.

    Article  Google Scholar 

  5. Costa F, van Klaveren D, James S, PRECISE-DAPT Study Investigators, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017;389:1025–34.

    Article  Google Scholar 

  6. Baber U, Mehran R, Giustino G, Cohen DJ, Henry TD, Sartori S, et al. Coronary thrombosis and major bleeding after PCI with drug-eluting stents: risk scores from PARIS. J Am Coll Cardiol. 2016;67:2224–34.

    Article  Google Scholar 

  7. Campo G, Pavasini R, Maietti E, Tonet E, Cimaglia P, Scillitani G, et al. The frailty in elderly patients receiving cardiac interventional procedures (FRASER) program: rational and design of a multicenter prospective study. Aging Clin Exp Res. 2017;29:895–903.

    Article  Google Scholar 

  8. Campo G, Maietti E, Tonet E, Biscaglia S, Ariza-Solè A, Pavasini R, et al. The assessment of scales of frailty and physical performance improves prediction of major adverse cardiac events in older adults with acute coronary syndrome. J Gerontol A Biol Sci Med Sci. 2019.

  9. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–77.

    Article  Google Scholar 

  10. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016;37:267–315.

    Article  CAS  Google Scholar 

  11. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Cardiovascular health study collaborative research group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

    Article  CAS  Google Scholar 

  12. Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.

    Article  CAS  Google Scholar 

  13. Pavasini R, Guralnik J, Brown JC, di Bari M, Cesari M, Landi F, et al. Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med. 2016;14:215.

    Article  Google Scholar 

  14. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  Google Scholar 

  15. Green P, Woglom AE, Genereux P, Daneault B, Paradis JM, Schnell S, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis: a single-center experience. JACC Cardiovasc Interv. 2012;5:974–81.

    Article  Google Scholar 

  16. Pilotto A, Ferrucci L, Franceschi M, D'Ambrosio LP, Scarcelli C, Cascavilla L, et al. Development and validation of a multidimensional prognostic index for 1-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res. 2008;11:151–61.

    Article  Google Scholar 

  17. Rolfson DB, Majumdar SR, Taher A, Tsuyuki RT. Development and validation of a new instrument for frailty. Clin Invest Med. 2000;23:336.

    Google Scholar 

  18. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation. 2011;123:2736–47.

    Article  Google Scholar 

  19. Valgimigli M, Costa F, Lokhnygina Y, et al. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the thrombin receptor antagonist for clinical event reduction in acute coronary syndrome (TRACER) randomized trial. Eur Heart J. 2017;38:804–10.

    CAS  PubMed  Google Scholar 

  20. Garot P, Morice MC, Tresukosol D, LEADERS FREE Investigators, et al. 2-year outcomes of high bleeding risk patients after polymer-free drug-coated stents. J Am Coll Cardiol. 2017;69:162–71.

    Article  Google Scholar 

  21. Raftery AE. Bayesian model selection in social research. Sociol Methodol. 1995;25:111.

    Article  Google Scholar 

  22. Pencina MJ, D’Agostino RB Sr, D’Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med. 2008;27:157–72.

    Article  Google Scholar 

  23. Aronow WS. Management of the elderly person after myocardial infarction. J Gerontol A Biol Sci Med Sci. 2004;59:1173–85.

    Article  Google Scholar 

  24. Vranckx P, Valgimigli M, Jüni P, GLOBAL LEADERS Investigators, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet. 2018;392:940–9.

    Article  CAS  Google Scholar 

  25. Valgimigli M, Campo G, Monti M, et al. Prolonging dual antiplatelet treatment after grading stent-induced intimal hyperplasia study (PRODIGY) investigators. Short- versus long-term duration of dual-antiplatelet therapy after coronary stenting: a randomized multicenter trial. Circulation. 2012;125:2015–26.

    Article  CAS  Google Scholar 

  26. Ariza-Solé A, Formiga F, Lorente V, et al. Efficacy of bleeding risk scores in elderly patients with acute coronary syndromes. Rev Esp Cardiol (Engl Ed). 2014;67:463–70.

    Article  Google Scholar 

  27. Ariza-Solé A, Guerrero C, Formiga F, et al. Global geriatric assessment and in-hospital bleeding risk in elderly patients with acute coronary syndromes: insights from the LONGEVO-SCA registry. Thromb Haemost. 2018;118:581–90.

    Article  Google Scholar 

  28. Alonso Salinas GL, Sanmartín Fernández M, Pascual Izco M, Marco del Castillo Á, Rincón Díaz LM, Lozano Granero C, et al. Frailty predicts major bleeding within 30days in elderly patients with acute coronary syndrome. Int J Cardiol. 2016;222:590–3.

    Article  Google Scholar 

  29. Dodson JA, Hochman JS, Roe MT, Chen AY, Chaudhry SI, Katz S, et al. The Association of Frailty with in-Hospital Bleeding among Older Adults with Acute Myocardial Infarction: insights from the ACTION registry. JACC Cardiovasc Interv. 2018;11:2287–96.

    Article  Google Scholar 

  30. Guerrero C, Ariza-Solé A, Formiga F, Martínez-Sellés M, Vidán MT, Aboal J. Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction. J Geriatr Cardiol. 2018;15:713–7.

    PubMed  PubMed Central  Google Scholar 

  31. Pavasini R, Serenelli M, Celis-Morales CA, Gray SR, Izawa KP, Watanabe S, et al. Grip strength predicts cardiac adverse events in patients with cardiac disorders: an individual patient pooled meta-analysis. Heart. 2018;105:834–41.

    Article  Google Scholar 

  32. Tonet E, Pavasini R, Biscaglia S, Campo G. Frailty in patients admitted to hospital for acute coronary syndrome: when, how and why? J Geriatr Cardiol. 2019;16:129–37.

    PubMed  PubMed Central  Google Scholar 

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Funding

The study was an investigator-driven clinical trial conducted by the University of Ferrara.

Author information

Authors and Affiliations

  1. Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro 8, 44124, Cona, Fe, Italy

    Rita Pavasini, Elisabetta Tonet, Giulia Bugani, Matteo Tebaldi, Simone Biscaglia, Paolo Cimaglia, Matteo Serenelli, Rossella Ruggiero, Francesco Vitali, Davide Bernucci & Gianluca Campo

  2. Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy

    Elisa Maietti

  3. Department of Medical Science, University of Ferrara, Ferrara, Italy

    Elisa Maietti & Stefano Volpato

  4. Unità Operativa di Cardiologia, Ospedale GB Morgagni, Forlì, Italy

    Marcello Galvani

  5. Department of Emergency, Division of Cardiology, Delta Hospital, Azienda Unità Sanitaria Locale di Ferrara, Ferrara, Italy

    Monica Minarelli

  6. Division of Cardiology, S. Maria Delle Croci Hospital, Ravenna, Italy

    Andrea Rubboli

  7. Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy

    Gianluca Campo

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  1. Rita Pavasini
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  2. Elisa Maietti
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Corresponding author

Correspondence to Gianluca Campo.

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The authors declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Pavasini, R., Maietti, E., Tonet, E. et al. Bleeding Risk Scores and Scales of Frailty for the Prediction of Haemorrhagic Events in Older Adults with Acute Coronary Syndrome: Insights from the FRASER study. Cardiovasc Drugs Ther 33, 523–532 (2019). https://doi.org/10.1007/s10557-019-06911-y

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