0266: Bleeding complications – predictors and prognosis in acute coronary syndromes

Abstract

Antithrombotic therapy and invasive revascularization play an important role in reducing ischemic events in Acute Coronary Syndromes (ACS), but paradoxically, increase the risk of bleeding complications (BC). We sought to determine the prevalence, predictors and prognostic value of BC in patients (P) admitted with ACS. Retrospective study including 1345 P with ACS consecutively admitted to a coronary care unit over 3 years and during a minimal 6 months follow-up . BC were defined according to TIMI or GUSTO classification systems. BC classified as minimal or mild were excluded. During hospitalization, 53 (3,9%) P developed BC and 1,7% had severe BC. P situação BC were older (70±12 vs 64±13y;p=0.002) and more often had chronic renal failure (15,1% vs 4,1%; p=0.002). At admission, they had more often signs of heart failure (HF) (49,1% vs 20,4%; p<0.001). They had higher mean levels of creatinine (p <0.001), cystatin C (p=0.023), type B natriuretic peptide (p<0.001) and red blood cell distribution width (RDW) (p=0.029), and lower mean levels of glomerular filtration rate (GFR), estimated either by MDRD equation (p<0.001) or Cockcroft-Gault equation (p<0.001). The echocardiographic evaluation showed that they had more often moderate to severe left ventricular systolic dysfunction (46,2% vs 31,9%; p=0.029). They were less likely to undergo invasive stratification (7,6% vs 1,6%; p<0.001), and when done, they had more often left main (22,6% vs 10,3%; p=0.028) and multivessel disease (66,0% vs 44,6%; p=0.002). After multivariate analysis, HF at admission, lower GFR and higher RDW persisted as independent predictors of BC. BC were an independent predictor of mortality (OR 4,20; CI 95%; 2,6-6,2; p <0,001) and in-hospital MACE (OR 6,8; CI 95%; 1,3-3,2; p <0,001), but this trend didn’t persisted in follow-up. BC predict a poor in-hospital outcome. Ischemic risk stratification plays a central role in optimal treatment approach and should be complemented by bleeding risk assessment. In this study, the presence at admission of HF, renal dysfunction and high RDW values were independent predictors of BC.