Ischaemic and haemorrhagic risk distribution in real-life patients with acute coronary syndromes

Abstract

Background

Effective treatment of non-ST-segment elevation acute coronary syndromes (NSTEACS) requires careful assessment of both ischaemic and bleeding risks. We aimed to analyse risk distribution and evaluate antiplatelet prescription behaviours in real-life settings.

Methods

Data from 1100 NSTEACS patients in Buenos Aires, Argentina, from the Buenos Aires I Registry, with a 15-month follow-up, were analysed. In-hospital and 6-month GRACE scores, CRUSADE, and Precise DAPT scores were calculated.

Results

The mean age was 65.4 ± 11.5 years with a majority being male (77.2%). In-hospital mortality was 2.7%, primarily due to cardiovascular causes (1.8%). Bleeding events occurred in 20.9% of patients, with 4.9% classified as ≥ BARC 3. Predominance of low bleeding (71.3%) and ischaemic (55.8%) risks on admission was observed. At 6 months, the low-risk Precise category (70.9%) and GRACE (44.1%) categories prevailed. Linear correlation analysis showed a moderately positive correlation (r = 0.61, p < .05) between ischaemic–haemorrhagic risks. Regarding the prescription of antiplatelet agents, in the low ischaemic–haemorrhagic risk group, there was a predominance of aspirin + clopidogrel (41.2%) over other high-potency antiplatelet regimens (aspirin + ticagrelor or prasugrel). In the low ischaemic and high haemorrhagic risk group, aspirin and clopidogrel were also predominant (58%).

Conclusions

Our analysis underscores the significant relationship between ischaemic and haemorrhagic risks during NSTEACS hospitalisation. Despite the majority of patients falling into the low-intermediate risk category, the prescription of P2Y12 inhibitors in real-life settings does not consistently align with these risks.

Keywords:

• Acute coronary syndrome
• ischaemic risk
• haemorrhagic risk
• clopidogrel
• prasugrel
• ticagrelor

Acknowledgements

List of participating centres and researchers in alphabetical order – Clínica Olivos: Sebastián Nani; San Lucas Clinic: Martín Odone; Zavala Clinic: Claudia Bruno; Sint Maarten Corporation: Fernando Guardiani; Favaloro Foundation: Ernesto Duronto; Argerich Hospital: Maximiliano Mascarello; Austral Hospital: Jorge Bilbao, José Bonorino and Nicolás Torres; Inter-American Open University Hospital: Ricardo Levín and Ignacio Vaca; Hospital Durán: Leandro Parrilla; Fernandez Hospital: Andrea Tufo Pereyra; Naval Hospital: Sofía Binder; Posadas Hospital: Natalia Carli; Santojanni Hospital: Carlos Ruano; Instituto Cardiovascular de Buenos Aires: Rosina Arbucci and Roberto Campos; Sanatorio Anchorena San Martín branch: Leandro Rodriguez; Sanatorio Anchorena, Recoleta branch: Paz Domínguez and Nicolás Lalor; Sanatorio Finochietto: Miguel Gonzalez and Guido Damianich; Sanatorio Güemes: Iván Gómez; Sanatorio la Trinidad Palermo: Andrea Tufo Pereyra; Sanatorio la Trinidad Quilmes: Christian Musante.

Ethical approval

All study participants were asked to sign a written informed consent form prior to inclusion. This form indicated the purpose of the study, outlined the confidential nature of the data, and the mechanisms used to protect the identity of the patients. Participation was stated to be voluntary, and patients could refuse to participate in the study without impacts to their medical care. Patients reserved the right to withdraw from the study at any time they wished. The consent form was submitted for approval by the ethics committees of all medical centres, following the regulations of the Central Ethics Committee. This study was carried out in compliance with the National Personal Data Protection Law N° 25.326. The identity of patients and their personal data was anonymous. Only researchers, members of the teaching team and research ethics committees (if required) had access to their data. The study was conducted in accordance with national ethical standards (Law No. 3301, National Law on Clinical Research on Human Subjects, Declaration of Helsinki, and others).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The authors declare that they did not have any grants for this investigation.