cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2020-2333cardiovascular-2333Research ArticleОСТРЫЙ КОРОНАРНЫЙ СИНДРОМACUTE CORONARY SYNDROMEШкалы риска кровотечений у больных с острым коронарным синдромом: место шкалы ОРАКУЛBleeding risk scales in patients with acute coronary syndrome: place of the ORACUL scalehttps://orcid.org/0000-0003-4144-4719БражникВ. А.BrazhnikV. A.

Кандидат медицинских наук, доцент кафедры терапии, кардиологии и функциональной диагностики; Главный врачГКБ № 51.

Москва

 

Moscow

vabrazhnik@bk.ruhttps://orcid.org/0000-0002-4203-3586МинушкинаЛ. О.MinushkinaL. O.

Доктор медицинских наук, профессор кафедры терапии, кардиологии и функциональной диагностики.

Москва, Тел.: +7 (903) 673-89-76

Moscow

minushkina@mail.ruhttps://orcid.org/0000-0002-8867-117XАверковаА. О.AverkovaA. O.

Аспирант кафедры терапии, кардиологии и функциональной диагностики.

Москва

Moscow

avek@mail.ruhttps://orcid.org/0000-0001-8377-1350ЗубоваЕ. А.ZubovaE. A.

Врач

Moscow

zubova.katerinka@inbox.ruhttps://orcid.org/0000-0001-8582-708XХасановН. Р.KhasanovN. R.

Доктор медицинских наук, доцент, заведующий кафедрой пропедевтики внутренних болезней

ybzp@mail.ruhttps://orcid.org/0000-0002-4510-6197ГалявичА. С.GalyavichA. S.

Доктор медицинских наук, профессор, заведующий кафедрой кардиологии ФПК и ППС

agalyavich@mail.ruhttps://orcid.org/0000-0002-6962-3260ЧичковаМ. А.ChichkovaM. A.

Доктор медицинских наук, профессор кафедры терапии, кардиологии и функциональной диагностики

Moscow

m.chichkova@mail.ruhttps://orcid.org/0000-0001-5690-2482КосмачеваЕ. Д.KosmachevaE. D.

ФГБОУ ВО “Кубанский государственный медицинский университет” Минздрава России

Krasnodar

kosmachova_h@mail.ruhttps://orcid.org/0000-0001-7065-2045ЗатейщиковД. А.ZateyshchikovD. A.

Доктор медицинских наук, профессор, заведующий кафедрой терапии, кардиологии и функциональной диагностики; заведующий первичным сосудистым отделением.

Москва

Moscow

dz@bk.ruФГБОУ ДПО “Центральная государственная медицинская академия” УД Президента РФ; ГБУЗ Городская клиническая больница № 51 ДЗ г. МосквыCentral State Medical Academy, Administrative Directorate of the President of the Russian Federation; City Clinical Hospital № 51ФГБОУ ДПО “Центральная государственная медицинская академия” УД Президента РФCentral State Medical Academy, Administrative Directorate of the President of the Russian FederationГБУЗ Городская клиническая больница № 51 ДЗ г. МосквыCity Clinical Hospital № 51ФГБОУ “Казанский государственный медицинский университет” Минздрава РоссииKazan State Medical UniversityФГБОУ ВО «Кубанский государственный медицинский университет» Минздрава РФ, КраснодарKuban State Medical University20201111202019523332333Copyright © Бражник В.А., Минушкина Л.О., Аверкова А.О., Зубова Е.А., Хасанов Н.Р., Галявич А.С., Чичкова М.А., Космачева Е.Д., Затейщиков Д.А., 20202020Бражник В.А., Минушкина Л.О., Аверкова А.О., Зубова Е.А., Хасанов Н.Р., Галявич А.С., Чичкова М.А., Космачева Е.Д., Затейщиков Д.А.Brazhnik V.A., Minushkina L.O., Averkova A.O., Zubova E.A., Khasanov N.R., Galyavich A.S., Chichkova M.A., Kosmacheva E.D., Zateyshchikov D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/2333Цель

Цель. Сравнить диагностическую ценность разных шкал оценки риска кровотечений в отечественной группе больных с острым коронарным синдромом (ОКС) с использованием различных систем классификации тяжести кровотечений.

Материал и методы

Материал и методы. В исследование включены больные из наблюдательного, открытого, многоцентрового исследования ОРАКУЛ II (ОбостРение ишемической болезни сердцА: логиКовероятностные пУти прогнозирования течения для оптимизации Лечения). В представленный анализ вошли данные о 1502 больных с ОКС. Средний возраст — 65,7±12,9 лет. На визитах наблюдения (выписка из стационара, 25, 90, 180 и 360 сут. от индексного события) фиксировались все случаи кровотечений с описанием характера кровотечений, источника, тяжести, проводимого лечения и классификации по шкалам BARC, TIMI и ISTH.

Результаты

Результаты. В период наблюдения кровотечения были зарегистрированы всего у 170 (11,3%) больных, в течение индексной госпитализации у 39 (2,6%), в течение года после индексной госпитализации у 131 (8,6%), у 19 (1,2%) больных регистрировались повторные кровотечения на нескольких визитах. Шкала ОРАКУЛ обладала наибольшей прогностической ценностью в отношении риска госпитальных кровотечений, превосходя по значимости такие шкалы как CRUSADE, ACTION-ICU, ACUITY, PARIS. Единственной шкалой с сопоставимой диагностической ценностью оказалась шкала BleeMACS. Следует отметить, что шкалы ORBIT и HASBLED обладали более низкой прогностической ценностью в отношении риска госпитальных кровотечений. В целом, все шкалы лучше предсказывали большие кровотечения и несколько хуже — клинически значимые.

Заключение

Заключение. Шкала риска кровотечений ОРАКУЛ выглядит наиболее приемлемым инструментом оценки риска кровотечений у больных после ОКС в условиях реальной отечественной клинической практики.

Aim

Aim. To compare the diagnostic value of different bleeding risk scales in patients with acute coronary syndrome (ACS).

Material and methods

Material and methods. The study included 1502 patients with ACS from the observational, open-label, multicenter trial ORACUL II. The mean age was 65,7±12,9 years. At follow-up visits (hospital discharge, 25, 90, 180 and 360 days from the index event), all cases of bleeding were recorded with a description of bleeding characteristics, source, severity, treatment, and classification according to the BARC, TIMI, and ISTH scales.

Results

Results. During the follow-up period, bleeding was recorded in only 170 (11,3%) patients: within the index hospitalization — in 39 (2б6%), within a year after the index hospitalization — in 131 (8,6%). In 19 (1,2%) patients, recurrent bleeding at several visits was recorded. In comparison with such scores as CRUSADE, ACTION-ICU, ACUITY, PARIS, the ORACUL scale had the highest predictive value in relation to the in-hospital bleeding risk. The only scale with comparable diagnostic value was the BleeMACS score. It should be noted that the ORBIT and HASBLED scores had a lower predictive value for the in-hospital bleeding risk. In general, all scores were better at predicting major bleeding and slightly worse for clinically relevant ones.

Conclusion

Conclusion. The ORACUL scale seems to be the most acceptable tool for assessing the bleeding risk in patients after ACS in actual clinical practice in Russia.

острый коронарный синдромкровотечениесмертностьшкала рискаacute coronary syndromebleedingmortalityrisk scoreИсследование было инициативным и проводилось под руководством кафедры терапии, кардиологии и функциональной диагностики ФГБУ ДПО “Центральная государственная медицинская академия” УД ПРФ. Внешние источники финансирования не использовалисьReferencesSabbag A, Guetta V, Fefer P, et al. Temporal Trends and Outcomes Associated with Major Bleeding in Acute Coronary Syndromes: A Decade-Long Perspective from the Acute Coronary Syndrome Israeli Surveys 2000-2010. Cardiology. 2015;132:163-71.15. doi:10.1159/000430838.Sabbag A, Guetta V, Fefer P, et al. Temporal Trends and Outcomes Associated with Major Bleeding in Acute Coronary Syndromes: A Decade-Long Perspective from the Acute Coronary Syndrome Israeli Surveys 2000-2010. Cardiology. 2015;132:163-71.15. doi:10.1159/000430838.Zocca P, Kok MM, van der Heijden LC, et al. High bleeding risk patients with acute coronary syndromes treated with contemporary drug-eluting stents and 16. Clopidogrel or Ticagrelor: Insights from CHANGE DAPT. Int J Cardiol. 2018;268:11-17. doi:10.1016/j.ijcard.2018.03.116.Zocca P, Kok MM, van der Heijden LC, et al. High bleeding risk patients with acute coronary syndromes treated with contemporary drug-eluting stents and 16. Clopidogrel or Ticagrelor: Insights from CHANGE DAPT. Int J Cardiol. 2018;268:11-17. doi:10.1016/j.ijcard.2018.03.116.Castini D, Centola M, Ferrante G, et al. Comparison of CRUSADE and ACUITY- 17.HORIZONS Bleeding Risk Scores in Patients with Acute Coronary Syndromes Heart Lung Circ. 2018;28(4):567-74. doi:10.1016/j.hlc.2018.02.012.Castini D, Centola M, Ferrante G, et al. Comparison of CRUSADE and ACUITY- 17.HORIZONS Bleeding Risk Scores in Patients with Acute Coronary Syndromes Heart Lung Circ. 2018;28(4):567-74. doi:10.1016/j.hlc.2018.02.012.Бражник В. А., Минушкина Л. О., Гулиев Р. Р. и др. Факторы риска кровотечений у больных с острым коронарным синдромом: дан- 19. ные наблюдательного исследования ОРАКУЛ II. Российский кардиологический журнал. 2019;(3):7-16. doi:10.15829/1560-4071-2019-3-7-16.Brazhnik VA, Minushkina LO, Guliev RR, et al. Bleeding risk factors in patients with acute coronary syndrome: data from observational studies ORACUL II. Russ J Cardiol. 2019;(3):7-16. (In Russ.) doi:10.15829/1560-4071-2019-3-7-16.Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736-47. doi:10.1161/CIRCU LATIO NAHA.110.009449.Mehran R, Rao SV, Bhatt DL, et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736-47. doi:10.1161/CIRCU LATIO NAHA.110.009449.Valgimigli M, Costa F, Lokhnygina Y, et al. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial. Eur Heart J. 2017;38(11):804-10. doi:10.1093/eurheartj/ehw525.Valgimigli M, Costa F, Lokhnygina Y, et al. Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial. Eur Heart J. 2017;38(11):804-10. doi:10.1093/eurheartj/ehw525.Caneiro-Queija B, Abu-Assi E, Raposeiras-Roubln S, et al. Differential Prognostic Impact on Mortality of Myocardial Infarction Compared With Bleeding Severity in Contemporary Acute Coronary Syndrome Patients. Rev Esp Cardiol (Engl Ed). 2018;71(10):829-36. doi:10.1016/j.rec.2018.02.008.Caneiro-Queija B, Abu-Assi E, Raposeiras-Roubln S, et al. Differential Prognostic Impact on Mortality of Myocardial Infarction Compared With Bleeding Severity in Contemporary Acute Coronary Syndrome Patients. Rev Esp Cardiol (Engl Ed). 2018;71(10):829-36. doi:10.1016/j.rec.2018.02.008.Rao SV, O'Grady K, Pieper KS, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol. 2005;96(9):1200-6. doi:10.1016/j.amjcard.2005.06.056.Rao SV, O'Grady K, Pieper KS, et al. Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol. 2005;96(9):1200-6. doi:10.1016/j.amjcard.2005.06.056.Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692-4. doi:10.1111/j.1538-7836.2005.01204.x.Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost. 2005;3(4):692-4. doi:10.1111/j.1538-7836.2005.01204.x.Аверкова А. О., Бражник В. А., Королева О. С. и др. Особенности течения острого коронарного синдрома у молодых больных с гиперлипидемией по данным наблюдательного проекта ОРАКУЛ II. Медицинский вестник Северного Кавказа. 2017;12(1):5-8. doi:10.14300/mnnc.2017.12001.Averkova AO, Brazhnik VA, Koroleva OS, et al. Acute coronary syndrome in young patients with familial hypercholesterolemia based on the results of ORACUL II observation trial. Medical news of north Caucasus. 2017;12(1):5-8. (In Russ.) doi:10.14300/mnnc.2017.12001.Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009;119(14):1873-82. doi:10.1161/CIRCULATIONAHA.108.828541.Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation. 2009;119(14):1873-82. doi:10.1161/CIRCULATIONAHA.108.828541.Mathews R, Peterson ED, Chen AY, et al. In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care: derivation and validation of a model from the ACTION Registry®-GWTG™. Am J Cardiol. 2011;107(8):1136-43. doi:10.1016/j.amjcard.2010.12.009.Mathews R, Peterson ED, Chen AY, et al. In-hospital major bleeding during ST-elevation and non-ST-elevation myocardial infarction care: derivation and validation of a model from the ACTION Registry®-GWTG™. Am J Cardiol. 2011;107(8):1136-43. doi:10.1016/j.amjcard.2010.12.009.Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556-66. doi:10.1016/j.jacc.2009.09.076.Mehran R, Pocock SJ, Nikolsky E, et al. A risk score to predict bleeding in patients with acute coronary syndromes. J Am Coll Cardiol. 2010;55(23):2556-66. doi:10.1016/j.jacc.2009.09.076.Raposeiras-Roubln S, Faxen J, Iniguez-Romo A, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. Int J Cardiol. 2018;254:10-5. doi: 10.1016/j.ijcard.2017.10.103.Raposeiras-Roubln S, Faxen J, Iniguez-Romo A, et al. Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score. Int J Cardiol. 2018;254:10-5. doi: 10.1016/j.ijcard.2017.10.103.Baber U, Mehran R, Giustino G, et al. Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS. J Am Coll Cardiol. 2016;67(19):2224-34. doi:10.1016/j.jacc.2016.02.064.Baber U, Mehran R, Giustino G, et al. Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS. J Am Coll Cardiol. 2016;67(19):2224-34. doi:10.1016/j.jacc.2016.02.064.Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727-33. doi:10.1001/jama.291.22.2727.Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004;291(22):2727-33. doi:10.1001/jama.291.22.2727.Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/ non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-42. doi:10.1001/jama.284.7.835.Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk score for unstable angina/ non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284(7):835-42. doi:10.1001/jama.284.7.835.O'Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36(46):3258-64. doi:10.1093/eurheartj/ehv476.O'Brien EC, Simon DN, Thomas LE, et al. The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation. Eur Heart J. 2015;36(46):3258-64. doi:10.1093/eurheartj/ehv476.Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100. doi:10.1378/chest.10-0134.Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest. 2010;138(5):1093-100. doi:10.1378/chest.10-0134.Ducrocq G, Schulte PJ, Budaj A, et al. Balancing the risk of spontaneous ischemic and major bleeding events in acute coronary syndromes. Am Heart J. 2017;186:91-9. doi:10.1016/j.ahj.2017.01.010.Ducrocq G, Schulte PJ, Budaj A, et al. Balancing the risk of spontaneous ischemic and major bleeding events in acute coronary syndromes. Am Heart J. 2017;186:91-9. doi:10.1016/j.ahj.2017.01.010.Manzano-Fernandez S, Sanchez-Martlnez M, Flores-Blanco PJ, et al. Comparison of the Global Registry of Acute Coronary Events Risk Score Versus the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse outcomes With Early Implementation of the ACC/AHA Guidelines Risk Score to Predict In-Hospital Mortality and Major Bleeding in Acute Coronary Syndromes. Am J Cardiol. 2016;117(7):1047-54. doi:10.1016/j.amjcard.2015.12.048.Manzano-Fernandez S, Sanchez-Martlnez M, Flores-Blanco PJ, et al. Comparison of the Global Registry of Acute Coronary Events Risk Score Versus the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse outcomes With Early Implementation of the ACC/AHA Guidelines Risk Score to Predict In-Hospital Mortality and Major Bleeding in Acute Coronary Syndromes. Am J Cardiol. 2016;117(7):1047-54. doi:10.1016/j.amjcard.2015.12.048.Taha S, D'Ascenzo F, Moretti C, et al. Accuracy of bleeding scores for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13759 patients. Postepy Kardiol Interwencyjnej. 2015;11(3): 182-90. doi:10.5114/pwki.2015.54011.Taha S, D'Ascenzo F, Moretti C, et al. Accuracy of bleeding scores for patients presenting with myocardial infarction: a meta-analysis of 9 studies and 13759 patients. Postepy Kardiol Interwencyjnej. 2015;11(3): 182-90. doi:10.5114/pwki.2015.54011.Amlani S, Nadarajah T, Afzal R, et al. Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction. J Thromb Thrombolysis. 2010;30(4):434-40. doi:10.1007/s11239-010-0462-8.Amlani S, Nadarajah T, Afzal R, et al. Mortality and morbidity following a major bleed in a registry population with acute ST elevation myocardial infarction. J Thromb Thrombolysis. 2010;30(4):434-40. doi:10.1007/s11239-010-0462-8.Nicolau JC, Moreira HG, Baracioli LM, et al. The bleeding risk score as a mortality predictor in patients with acute coronary syndrome. Arq Bras Cardiol. 2013;101(6):511-8. doi:10.5935/abc.20130223.Nicolau JC, Moreira HG, Baracioli LM, et al. The bleeding risk score as a mortality predictor in patients with acute coronary syndrome. Arq Bras Cardiol. 2013;101(6):511-8. doi:10.5935/abc.20130223.Zhao XY, Li JX, Tang XF, et al. Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions. Chin Med J (Engl). 2018;131(3):262-7. doi:10.4103/0366-6999.223858.Zhao XY, Li JX, Tang XF, et al. Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions. Chin Med J (Engl). 2018;131(3):262-7. doi:10.4103/0366-6999.223858.Bang J, Choi SY, Kim MH, et al. CRUSADE Score is Superior to Platelet Function Testing for Prediction of Bleeding in Patients Following Coronary Interventions. EBioMedicine. 2017;21:213-7. doi:10.1016/j.ebiom.2017.05.010.Bang J, Choi SY, Kim MH, et al. CRUSADE Score is Superior to Platelet Function Testing for Prediction of Bleeding in Patients Following Coronary Interventions. EBioMedicine. 2017;21:213-7. doi:10.1016/j.ebiom.2017.05.010.Al-Daydamony MM, Farag EM. CRUSADE bleeding score as a predictor of bleeding events in patients with acute coronary syndrome in Zagazig University Hospital. Indian Heart J. 2016;68(5):632-8. doi:10.1016/j.ihj.2016.03.007.Al-Daydamony MM, Farag EM. CRUSADE bleeding score as a predictor of bleeding events in patients with acute coronary syndrome in Zagazig University Hospital. Indian Heart J. 2016;68(5):632-8. doi:10.1016/j.ihj.2016.03.007.Sanchez-Martlnez M, Flores-Blanco PJ, Lopez-Cuenca AA, et al. Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes. Cardiorenal Med. 2017;7(3):179-87. doi:10.1159/000455102.Sanchez-Martlnez M, Flores-Blanco PJ, Lopez-Cuenca AA, et al. Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction and Acute Coronary Syndromes. Cardiorenal Med. 2017;7(3):179-87. doi:10.1159/000455102.Faustino A, Mota P, Silva J; researchers from the National Registry of Acute Coronary Syndromes, Portuguese Cardiology Society. Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores. Rev Port Cardiol. 2014;33(10):617-27. doi:10.1016/j.repc.2014.01.025.Faustino A, Mota P, Silva J; researchers from the National Registry of Acute Coronary Syndromes, Portuguese Cardiology Society. Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores. Rev Port Cardiol. 2014;33(10):617-27. doi:10.1016/j.repc.2014.01.025.Abu-Assi E, Raposeiras-Roubin S, Cobas-Paz R, et al. Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients. EuroIntervention. 2018;13(16):1914-22. doi:10.4244/EIJ-D-17-00550.Abu-Assi E, Raposeiras-Roubin S, Cobas-Paz R, et al. Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients. EuroIntervention. 2018;13(16):1914-22. doi:10.4244/EIJ-D-17-00550.

The authors declare that there are no conflicts of interest present.