Faculty of Medicine

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Development and external validation of a post-discharge bleeding risk score in patients with acute coronary syndrome: The BleeMACS score
(Elsevier BV, 2018-03-01)
Raposeiras-Roubín, Sergio
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Faxén, Jonas
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Íñiguez-Romo, Andrés
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Henriques, Jose Paulo Simao
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D'Ascenzo, Fabrizio
Accurate 1-year bleeding risk estimation after hospital discharge for acute coronary syndrome (ACS) may help clinicians guide the type and duration of antithrombotic therapy. Currently there are no predictive models for this purpose. The aim of this study was to derive and validate a simple clinical tool for bedside risk estimation of 1-year post-discharge serious bleeding in ACS patients.
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Complete or incomplete coronary revascularisation in patients with myocardial infarction and multivessel disease: a propensity score analysis from the “real-life” BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry
(Europa Digital & Publishing, 2017-07)
Quadri, Giorgio
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D’Ascenzo, Fabrizio
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Moretti, Claudio
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D’Amico, Maurizio
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Raposeiras-Roubín, Sergio
Aims: The benefit of complete or incomplete percutaneous coronary intervention (PCI) in patients with myocardial infarction and multivessel disease remains debated. The aim of our study was to compare a complete vs. a “culprit only” revascularisation strategy in patients with myocardial infarction distinguishing the different clinical subsets (STEMI and NSTEMI) and to provide one-year clinical outcome from the “real-life” BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry. Methods and results: We conducted a multicentre study including all patients with myocardial infarction and multivessel coronary disease included in the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged with diagnosis of Acute Coronary Syndrome) registry. They were divided into two groups, complete revascularisation (CR) and incomplete revascularisation (IR). The primary endpoint was the death rate at one-year follow-up. Secondary endpoints were in-hospital repeat myocardial infarction (re-AMI), in-hospital heart failure (HF), major adverse cardiovascular events (MACE) and myocardial infarction at one year. Four thousand five hundred and twenty patients were included in our analysis, with a diagnosis of STEMI in 67.7% and NSTEMI in 32.3%. CR was performed in 27.2% and 42.4%, respectively. At univariate analysis, in-hospital and one-year outcomes were similar between CR and IR in STEMI patients (all p-values >0.05). In NSTEMI patients, CR was associated with a lower one-year death rate (4.5% vs. 8.5%; p=0.002), re-AMI (3.7% vs. 6.6%; p=0.016) and MACE (8.1% vs. 13.9%; p=0.001). After propensity score matching, CR also reduced events in STEMI patients, including one-year mortality (5.3% vs. 13.8%; p<0.001), re-AMI (4.9% vs. 17.4%; p<0.001) and MACE (8.5% vs. 24.6%; p<0.001). Conclusions: This multicentre retrospective registry showed the benefit of CR in terms of reduction of one-year mortality in patients with myocardial reinfarction and multivessel coronary disease. Randomised controlled trials including functional evaluation of the lesions should be performed to confirm our results.
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Association of Beta-Blockers with Survival on Patients Presenting with ACS Treated with PCI: A Propensity Score Analysis from the BleeMACS Registry
(Springer Science and Business Media LLC, 2018-08)
D'Ascenzo, Fabrizio
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Celentani, Dario
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Brustio, Alessandro
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Grosso, Alberto
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Raposeiras-Roubín, Sergio
The aim was to evaluate prognostic value of beta-blocker (BB) administration in acute coronary syndromes (ACS) patients in the percutaneous coronary intervention (PCI) era.
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Gender-related differences in post-discharge bleeding among patients with acute coronary syndrome on dual antiplatelet therapy: A BleeMACS sub-study
(Elsevier BV, 2018-08)
Grodecki, Kajetan
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Huczek, Zenon
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Scisło, Piotr
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Kowara, Michał
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Raposeiras-Roubín, Sergio
Bleeding is an independent risk factor of mortality in patients with acute coronary syndromes (ACS). BleeMACS project focuses on long-term bleeding events after hospital discharge, thus we evaluated gender-related differences in post-discharge bleeding among patients with ACS.
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Safety and effectiveness of the new P2Y12r inhibitor agents vs clopidogrel in ACS patients according to the geographic area: East Asia vs Europe
(Elsevier BV, 2016-10-01)
Giordana, Francesca
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Montefusco, Antonio
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D'Ascenzo, Fabrizio
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Moretti, Claudio
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Scarano, Silvia
Background In the setting of the Acute Coronary Syndrome (ACS), differences in response to prasugrel and ticagrelor between East Asian and European patients have not been investigated yet. Methods This is a sub-analysis of the “BleeMACS registry”. Patients admitted for ACS and underwent PCI from between 2012 and 2014 were stratified first according to their provenance, Europe vs. East Asia (China and Japan), and then by country. The adjusted rate of 1-year serious bleeding -safety end-point- and 1-year death/re-infarction -effectiveness endpoint- of the new P2Y12r inhibitors were compared. Results Data of 10004 patients in Europe and 2332 patients in East Asia were collected. At baseline prior stroke (6% vs 9%, p<0.001, respectively) and type of ACS (59% vs 71% STEMI, 11% vs 21% Unstable Angina) were significantly different among the groups. At 1year follow-up no difference in bleeding (3% vs 3%, p=0.84) was found, while the between group incidence of death/re-infarction was significantly higher in the European centers (9% vs 5%, p<0.001). At the multivariate analysis, ticagrelor decreases the risk of MACE (Europe: HR 0.5, CI 0.3–0.9; East Asia: HR 0.5, CI 0.2–0.9), despite of a higher risk of bleeding in Caucasians (HR 1.7, CI 1.1–2.6). Prasugrel reduces death/re-infarction (HR 0.4, CI 0.2–0.6), without increasing bleeding (HR 0.9, CI 0.5–1.3). Conclusions In the setting of the ACS, the new anti-platelets drugs appear to be safe and efficacious at mid-term follow-up independently from the geographic area. Prasugrel seems to have the best risk–benefit, while ticagrelor appears safer in East Asians.
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Incidence, predictors and prognostic impact of intracranial bleeding within the first year after an acute coronary syndrome in patients treated with percutaneous coronary intervention
(SAGE Publications, 2019-05-01)
Raposeiras-Roubín, Sergio
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Abu-Assi, Emad
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Caneiro Queija, Berenice
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Cobas Paz, Rafael
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D'Ascenzo, Fabrizio
The rate of intracranial haemorrhage after an acute coronary syndrome has been studied in detail in the era of thrombolysis; however, in the contemporary era of percutaneous coronary intervention, most of the data have been derived from clinical trials. With this background, we aim to analyse the incidence, timing, predictors and prognostic impact of post-discharge intracranial haemorrhage in patients with acute coronary syndrome undergoing percutaneous coronary intervention.
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Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction
(Elsevier BV, 2020-02)
Raposeiras-Roubín, Sergio
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Abu-Assi, Emad
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Cespón-Fernández, María
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Ibáñez, Borja
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García-Ruiz, José Manuel
For patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI), it is unclear whether angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are associated with reduced mortality, particularly with preserved left ventricular ejection fraction (LVEF). The goal of this study was to determine the association between ACEI/ARB and mortality in ACS patients undergoing PCI, with and without reduced LVEF.
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Antithrombotic Therapy in Patients With Prior Stroke/Transient Ischemic Attack and Acute Coronary Syndromes
(SAGE Publications, 2020)
Zhang, Dongfeng
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Song, Xiantao
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Chen, Yalei
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Raposeiras-Roubín, Sergio
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Abu-Assi, Emad
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Outcome of Patients With Prior Stroke/Transient Ischemic Attack and Acute Coronary Syndromes
(SAGE Publications, 2020-04)
Zhang, Dongfeng
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Song, Xiantao
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Chen, Yalei
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Raposeiras-Roubín, Sergio
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Abu-Assi, Emad
The association between prior stroke/transient ischemic attack (TIA) and clinical outcomes in patients with acute coronary syndrome (ACS) has not been well explored. We evaluated the impact of prior stroke/TIA on this specific patient population. We conducted an international multicenter study including 15 401 patients with ACS from the Bleeding Complications in a Multicenter Registry of Patients Discharged With Diagnosis of Acute Coronary Syndrome registry. They were divided into 2 groups: patients with and without prior stroke/TIA. The primary end point was death at 1-year follow-up. Prior stroke/TIA was associated with higher rate of 1-year death (8.7% vs 3.4%; P < .001). It was an independent predictor of 1-year death even after adjustment for confounding variables (odds ratio, 1.705; 95% confidence interval, 1.046-2.778; P = .032). Besides, patients with prior stroke/TIA had significantly increased 1-year reinfarction (5.6% vs 3.8%, P = .015), in-hospital bleeding (8.7% vs 5.8%, P < .001), and 1-year bleeding (5.2% vs 3.0%, P < .001). No difference of antithrombotic therapies or dual antiplatelet therapy (DAPT) types on outcomes was observed in patients with prior stroke/TIA. Prior stroke/TIA was associated with higher 1-year death for patients with ACS who underwent percutaneous coronary intervention. No benefits or harms were observed with different antithrombotic therapies or DAPT types in these patients.

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