Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction

Background Elderly patients with acute coronary syndromes(ACS)are at higher risk both for ischemic and bleeding complications.Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting,but no study assessed its applicability in elderly patients.This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice.Methods The IFFANIAM registry included prospectively patients aged>75 years with ST segment elevation myocardial infarction(STEMI).Main outcome measured was the incidence of relevant bleeding after discharge(bleeding leading to hospital readmission,need for transfusion,intervention,stop of antithrombotic drugs or death).Bleeding risk was classified:(A)according to PRECISE-DAPT values above or not the recommended cut-off point(>25);and(B)according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series(QI:<30;Q2:30-35;Q3:36-44;Q4:>45).Results A total of 208 patients were included.Mean age was 81.9±4.5 years.Most patients(92.6%)had a PRECISE-DAPT value>25.A total of 25 patients(12.0%)had bleeding events and 49 patients(23.6%)died.No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point>25.However,a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series(P=0.038).Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk.Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.

Anemia in patients with high-risk acute coronary syndromes admitted to Intensive Cardiac Care Units

Background Little information exists about the role of anemia in patients with acute coronary syndromes(ACS)admitted to Intensive Cardiac Care Units(ICCU).The aim of this study was to assess the prevalence of anemia and its impact on management and outcomes in this clinical setting.Methods All consecutive patients admitted to eight different ICCUs with diagnosis of non-ST segment elevation ACS(NSTEACS)were prospectively included.Anemia was defined as hemoglobin<130 g/L in men and<120 g/L in women.The association between anemia and mortality or readmission at six months was assessed by the Cox regression method.Results A total of 629 patients were included.Mean age was 66.6 years.A total of 197 patients(31.3%)had anemia.Coronary angiography was performed in most patients(96.2%).Patients with anemia were significantly older,with a higher prevalence of comorbidities,poorer left ventricle ejection fraction and higher GRACE score values.Patients with anemia underwent less often coronary angiography,but underwent more often intraaortic counterpulsation,non-invasive mechanical ventilation and renal replacement therapies.Both ICCU and hospital stay were significantly longer in patients with anemia.Both the incidence of mortality(HR=3.36,95%CI:1.43–7.85,P=0.001)and the incidence of mortality/readmission were significantly higher in patients with anemia(HR=2.80,95%CI:2.03–3.86,P=0.001).After adjusting for confounders,the association between anemia and mortality/readmission remained significant(P=0.031).Conclusions Almost one of three NSTEACS patients admitted to ICCU had anemia.Most patients underwent coronary angiography.Anemia was independently associated to poorer outcomes at 6 months.