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™

Study Questions:

What are the predictors of major bleeding in patients with myocardial infarction (MI)?


The authors developed a risk model for predicting risk of bleeding in patients with ST-elevation MI (STEMI) and non-STEMI. Only presenting variables were included in the model.


The rate of major bleeding was 10.8%. The final model included 12 variables: heart rate, baseline hemoglobin, female gender, baseline serum creatinine, age, electrocardiographic changes, heart failure or shock, diabetes, peripheral artery disease, body weight, systolic blood pressure, and home warfarin use. The risk model discriminated reasonably well in the derivation (C-statistic = 0.73) and validation (C-statistic = 0.71) cohorts. The observed rate of major bleeding in individuals with very low risk (3.9%), low risk (7.3%), moderate risk (16.1%), high risk (29.0%), and very high risk (39.8%) corresponded to the predicted risk.


This model from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG), using variables at presentation, provides a robust tool for predicting major bleeding.


This model, by only including the presenting variables, provides a useful tool to compare outcomes across sites, and would be of value in guiding quality improvement initiatives. The utility of this model for patient-level decision making is unclear and needs further study before it can be incorporated into routine clinical practice.

Clinical Topics: Vascular Medicine, Atherosclerotic Disease (CAD/PAD)

Keywords: Myocardial Infarction, Hemoglobins, Peripheral Arterial Disease, Hemorrhage, Diabetes Mellitus

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