Predictive performance of HAS-BLED risk score for long-term survival in patients with non-ST elevated myocardial infarction without atrial fibrillation

Ming Jer Hsieh, Cheng Hung Lee, Chun Chi Chen, Shang Hung Chang, Chao Yung Wang, I. Chang Hsieh*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

12 Scopus citations

Abstract

Background Predictive value of the Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly, Drugs or alcohol use (HAS-BLED) score for clinical outcomes has been investigated in patients with and without atrial fibrillation. Many factors in the HAS-BLED model have been reported to be prognostic predictors in patients with post-myocardial infarction (MI). However, few studies have investigated the predictive value of HAS-BLED score on long-term survival in patients with post-MI. Methods A total of 617 patients with non-ST elevation MI (NSTEMI) without atrial fibrillation were enrolled. The Thrombolysis In Myocardial Infarction (TIMI), Global Registry of Acute Coronary Events (GRACE), Can Rapid Risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE), and HAS-BLED risk scores were calculated for each patient. Results The C-statistics of TIMI, GRACE, CRUSADE, and HAS-BLED scores for 3-year survival were 0.658, 0.749, 0.756, and 0.765, respectively. For 3-year survival prediction, GRACE, CRUSADE, and HAS-BLED scores, respectively demonstrated superior performance than TIMI score and there was no significant difference between these three scores (GRACE vs. TIMI: z = 1.615, p = 0.027; CRUSADE vs. TIMI: z = 1.371, p = 0.043; HAS-BLED vs. TIMI: z = 1.899, p = 0.014; CRUSADE vs. GRACE: z = 0.078, p = 0.234; HAS-BLED vs. GRACE: z = 0.435, p = 0.166; HAS-BLED vs. CRUSADE: z = 0.353, p = 0.181). Multivariate analysis showed left ventricular ejection fraction <40%, old age, stroke history, bleeding history, and abnormal renal and liver function were independent predictors for 3-year mortality. Conclusions HAS-BLED scoring system is similar to the GRACE and CRUSADE systems but better than TIMI system to predict long-term survival outcomes in patients with NSTEMI without atrial fibrillation. However, HAS-BLED score is easier to calculate than GRACE and CRUSADE scores.

Original languageEnglish
Pages (from-to)136-143
Number of pages8
JournalJournal of Cardiology
Volume69
Issue number1
DOIs
StatePublished - 01 01 2017

Bibliographical note

Publisher Copyright:
© 2016 Japanese College of Cardiology

Keywords

  • CRUSADE
  • GRACE
  • HAS-BLED
  • NSTEMI
  • Survival
  • TIMI

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