Letter to the Editor
Reply to the Letter to the Editor entitled “Bleeding risk assessment and comorbidities in elderly patients with acute coronary syndromes”
Resposta à Carta ao Editor intitulada «Avaliação do risco hemorrágico e comorbilidades em doentes idosos com síndromes coronárias agudas»
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[ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Paula" "apellidos" => "Mota" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Joana" "apellidos" => "Silva" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Centro Hospitalar do Baixo Vouga – EPE, Aveiro, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cardiology Department, William Harvey Hospital, Ashford Kent, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Cardiologia B, Centro Hospitalar e Universitário de Coimbra – EPE, Coimbra, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Resposta à Carta ao Editor intitulada «Avaliação do risco hemorrágico e comorbilidades em doentes idosos com síndromes coronárias agudas»" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We appreciate the interest of A Ariza-Solé, F Formiga, E Bernal and A Garay in our recent original paper entitled “Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores”,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> and would like to thank them for their pertinent comments.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Despite the increasing prevalence and higher cardiovascular risk of elderly patients, evidence regarding the management of non-ST-elevation acute coronary syndromes (NSTE-ACS) in this age-group is scarce and not representative of real practice, since they are often excluded from clinical trials. Thus, we felt that a national registry, such as the Portuguese Registry on Acute Coronary Syndromes (ProACS),<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> would be a good opportunity to address this knowledge gap. Unfortunately, in the ProACS, major bleeding was defined using the GUSTO criteria,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> and data on baseline hematocrit and witnessed bleeding were not available.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Thus, we were unable to define major bleeding using the same criteria as used for the validation of CRUSADE.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> We agree that using the GUSTO criteria for defining major bleeding while assessing the accuracy of the CRUSADE score may be a limitation. Nevertheless, a c-statistic of 0.5 truly shows a performance that can be described as mere chance, comparable to flipping a coin. Furthermore, we considered that as CRUSADE is currently recommended by the European Society of Cardiology to assess the risk of bleeding in patients with NSTE-ACS,<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">6,7</span></a> it should be able to identify patients who suffered clinically significant bleeding, even if this is major bleeding as defined by the GUSTO criteria.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Our finding that the CRUSADE score is unsuitable for assessing bleeding risk in octogenarian patients is in line with the study by Ariza-Solé et al.,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> which included 369 patients aged ≥75 years and found a significantly worse performance by the CRUSADE score for discrimination of major bleeding in this age-group, compared to younger patients. To summarize, our conclusions overlap those of Ariza-Solé and colleagues,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> as we also believe that the development of new scores to assess bleeding risk in the elderly should be the aim of future research.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Non-ST-elevation acute coronary syndromes in octogenarians: applicability of the GRACE and CRUSADE scores" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "for the National Registry of Acute Coronary Syndromes, Portuguese Society of Cardiology" "etal" => false "autores" => array:3 [ 0 => "A. 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Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rec.2013.10.008" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2014" "volumen" => "67" "paginaInicial" => "463" "paginaFinal" => "470" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863595" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003500000004/v2_201703300127/S2174204916300113/v2_201703300127/en/main.assets" "Apartado" => array:4 [ "identificador" => "29282" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003500000004/v2_201703300127/S2174204916300113/v2_201703300127/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204916300113?idApp=UINPBA00004E" ]
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| 2024 February | 65 | 29 | 94 |
| 2024 January | 24 | 30 | 54 |
| 2023 December | 22 | 14 | 36 |
| 2023 November | 19 | 19 | 38 |
| 2023 October | 20 | 17 | 37 |
| 2023 September | 22 | 18 | 40 |
| 2023 August | 17 | 17 | 34 |
| 2023 July | 18 | 12 | 30 |
| 2023 June | 17 | 13 | 30 |
| 2023 May | 28 | 21 | 49 |
| 2023 April | 8 | 1 | 9 |
| 2023 March | 16 | 24 | 40 |
| 2023 February | 17 | 18 | 35 |
| 2023 January | 21 | 14 | 35 |
| 2022 December | 22 | 31 | 53 |
| 2022 November | 22 | 18 | 40 |
| 2022 October | 21 | 12 | 33 |
| 2022 September | 27 | 31 | 58 |
| 2022 August | 23 | 24 | 47 |
| 2022 July | 19 | 36 | 55 |
| 2022 June | 15 | 14 | 29 |
| 2022 May | 20 | 26 | 46 |
| 2022 April | 17 | 27 | 44 |
| 2022 March | 17 | 18 | 35 |
| 2022 February | 19 | 27 | 46 |
| 2022 January | 18 | 25 | 43 |
| 2021 December | 14 | 23 | 37 |
| 2021 November | 26 | 35 | 61 |
| 2021 October | 25 | 42 | 67 |
| 2021 September | 16 | 24 | 40 |
| 2021 August | 17 | 27 | 44 |
| 2021 July | 11 | 22 | 33 |
| 2021 June | 14 | 12 | 26 |
| 2021 May | 22 | 38 | 60 |
| 2021 April | 26 | 33 | 59 |
| 2021 March | 29 | 22 | 51 |
| 2021 February | 37 | 20 | 57 |
| 2021 January | 37 | 9 | 46 |
| 2020 December | 21 | 11 | 32 |
| 2020 November | 29 | 9 | 38 |
| 2020 October | 20 | 12 | 32 |
| 2020 September | 40 | 24 | 64 |
| 2020 August | 12 | 6 | 18 |
| 2020 July | 23 | 14 | 37 |
| 2020 June | 32 | 11 | 43 |
| 2020 May | 30 | 4 | 34 |
| 2020 April | 20 | 16 | 36 |
| 2020 March | 22 | 8 | 30 |
| 2020 February | 40 | 34 | 74 |
| 2020 January | 18 | 9 | 27 |
| 2019 December | 25 | 11 | 36 |
| 2019 November | 19 | 6 | 25 |
| 2019 October | 28 | 8 | 36 |
| 2019 September | 23 | 7 | 30 |
| 2019 August | 14 | 7 | 21 |
| 2019 July | 26 | 12 | 38 |
| 2019 June | 18 | 12 | 30 |
| 2019 May | 28 | 11 | 39 |
| 2019 April | 14 | 10 | 24 |
| 2019 March | 24 | 11 | 35 |
| 2019 February | 36 | 10 | 46 |
| 2019 January | 14 | 7 | 21 |
| 2018 December | 20 | 15 | 35 |
| 2018 November | 25 | 8 | 33 |
| 2018 October | 62 | 15 | 77 |
| 2018 September | 23 | 13 | 36 |
| 2018 August | 31 | 4 | 35 |
| 2018 July | 16 | 2 | 18 |
| 2018 June | 31 | 7 | 38 |
| 2018 May | 54 | 19 | 73 |
| 2018 April | 41 | 10 | 51 |
| 2018 March | 74 | 16 | 90 |
| 2018 February | 46 | 5 | 51 |
| 2018 January | 100 | 8 | 108 |
| 2017 December | 111 | 6 | 117 |
| 2017 November | 25 | 16 | 41 |
| 2017 October | 22 | 14 | 36 |
| 2017 September | 10 | 6 | 16 |
| 2017 August | 19 | 16 | 35 |
| 2017 July | 12 | 17 | 29 |
| 2017 June | 27 | 8 | 35 |
| 2017 May | 20 | 7 | 27 |
| 2017 April | 33 | 3 | 36 |
| 2017 March | 28 | 70 | 98 |
| 2017 February | 13 | 7 | 20 |
| 2017 January | 12 | 3 | 15 |
| 2016 December | 20 | 8 | 28 |
| 2016 November | 19 | 6 | 25 |
| 2016 October | 32 | 6 | 38 |
| 2016 September | 10 | 7 | 17 |
| 2016 August | 4 | 1 | 5 |
| 2016 July | 9 | 8 | 17 |
| 2016 June | 14 | 13 | 27 |
| 2016 May | 14 | 31 | 45 |
| 2016 April | 6 | 6 | 12 |
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