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

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 discharge.The 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 date.RESULTS: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 scores.In 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 mortality.An 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 Curve 0.703,Hosmer-Lemeshow test P value 0.547,Brier score 0.060;low-risk(BLEED-MI score 0-3) event rate:1.2%;intermediate risk(score 4-6) event rate:5.6%;high risk(score ≥ 7) event rate:12.5%.CONCLUSION:A new bedside prediction-scoring model for post-discharge mid-term bleeding has been derived and preliminarily validated.This is the first score designed to predict mid-term hemorrhagic risk in patients discharged following admission for acute MI.This model should be externally validated in larger cohorts of patients before its potential implementation.