Sérgio Barra, Rui Providência, Francisca Caetano, Inês Almeida, Luís Paiva, Paulo Dinis, António Leitão Marques BLEED-Myocardial Infarction Score: Predicting mid-term post-discharge bleeding events Sérgio Barra, Rui Providência, Francisca Caetano, Inês Almeida, Luís Paiva, Paulo Dinis, António Leitão Marques, Cardiology Department, Coimbra’s Hospital and University Cen- tre-General Hospital, 3041-801 S. Martinho do Bispo, Coimbra, Portugal Rui Providência, Faculty of Medicine, University of Coimbra, 3046-853 Coimbra, Portugal Author contributions: Barra S designed the study; Barra S and Providência R wrote the draft version of the article; Leitão Marques A co-ordinated the development of the manuscript; all authors contributed to the collection of data, reviewed the draft version, gave advice for improving the manuscript and read and approved the inal version. Correspondence to: Dr. Sérgio Barra, Cardiology Depart- ment, Coimbra’s Hospital and University Centre-General Hospi- tal, Quinta dos Vales, 3041-801 S. Martinho do Bispo, Coimbra, Portugal. sergioncbarra@gmail.com Telephone: +351-916-685716 Fax: +351-239-445737 Received: February 21, 2013 Revised: April 23, 2013 Accepted: May 16, 2013 Published online: June 26, 2013 Abstract 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 ifty patients admitted for MI and followed for 19.9 ± 6.7 mo were assigned to a derivation cohort. A new risk model, called BLEED- MI, 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), incor- porating the following variables: age, diabetes mel- litus, arterial hypertension, smoking habits, blood urea nitrogen, glomerular iltration rate and hemoglobin at admission, history of stroke, bleeding during hospital- ization or previous major bleeding, heart failure during hospitalization and anti-thrombotic therapies prescribed at discharge. The BLEED-MI model was tested for cali- bration, 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 calibra- tion in both derivation and validation samples (Hosmer- Lemeshow 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 discrimina- tive 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 in- creased 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 end- point of post-discharge hemorrhage plus all-cause mor- tality. An accurate prediction of bleeding events was shown independently of mortality, as BLEED-MI pre- dicted bleeding with similar eficacy 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%; in- termediate 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 co- horts of patients before its potential implementation. © 2013 Baishideng. All rights reserved. Key words: Myocardial infarction; Bleeding; Prediction model; Risk stratiication BRIEF ARTICLE 196 June 26, 2013|Volume 5|Issue 6| WJC|www.wjgnet.com Online Submissions: http://www.wjgnet.com/esps/ wjc@wjgnet.com doi:10.4330/wjc.v5.i6.196 World J Cardiol 2013 June 26; 5(6): 196-206 ISSN 1949-8462 (online) © 2013 Baishideng. All rights reserved. World Journal of Cardiology WJC