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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| 2024 Junho | 28 | 24 | 52 |
| 2024 Maio | 36 | 15 | 51 |
| 2024 Abril | 32 | 20 | 52 |
| 2024 Maro | 34 | 22 | 56 |
| 2024 Fevereiro | 31 | 32 | 63 |
| 2024 Janeiro | 25 | 32 | 57 |
| 2023 Dezembro | 30 | 20 | 50 |
| 2023 Novembro | 34 | 21 | 55 |
| 2023 Outubro | 17 | 15 | 32 |
| 2023 Setembro | 17 | 20 | 37 |
| 2023 Agosto | 25 | 16 | 41 |
| 2023 Julho | 23 | 12 | 35 |
| 2023 Junho | 26 | 9 | 35 |
| 2023 Maio | 29 | 15 | 44 |
| 2023 Abril | 12 | 5 | 17 |
| 2023 Maro | 27 | 15 | 42 |
| 2023 Fevereiro | 31 | 23 | 54 |
| 2023 Janeiro | 13 | 6 | 19 |
| 2022 Dezembro | 35 | 15 | 50 |
| 2022 Novembro | 27 | 21 | 48 |
| 2022 Outubro | 19 | 19 | 38 |
| 2022 Setembro | 28 | 30 | 58 |
| 2022 Agosto | 28 | 26 | 54 |
| 2022 Julho | 23 | 34 | 57 |
| 2022 Junho | 17 | 17 | 34 |
| 2022 Maio | 28 | 32 | 60 |
| 2022 Abril | 20 | 27 | 47 |
| 2022 Maro | 15 | 27 | 42 |
| 2022 Fevereiro | 23 | 29 | 52 |
| 2022 Janeiro | 25 | 26 | 51 |
| 2021 Dezembro | 17 | 28 | 45 |
| 2021 Novembro | 25 | 29 | 54 |
| 2021 Outubro | 37 | 38 | 75 |
| 2021 Setembro | 27 | 31 | 58 |
| 2021 Agosto | 34 | 21 | 55 |
| 2021 Julho | 20 | 24 | 44 |
| 2021 Junho | 30 | 19 | 49 |
| 2021 Maio | 20 | 30 | 50 |
| 2021 Abril | 14 | 26 | 40 |
| 2021 Maro | 50 | 14 | 64 |
| 2021 Fevereiro | 63 | 14 | 77 |
| 2021 Janeiro | 29 | 9 | 38 |
| 2020 Dezembro | 25 | 8 | 33 |
| 2020 Novembro | 29 | 14 | 43 |
| 2020 Outubro | 20 | 15 | 35 |
| 2020 Setembro | 74 | 11 | 85 |
| 2020 Agosto | 24 | 11 | 35 |
| 2020 Julho | 34 | 15 | 49 |
| 2020 Junho | 32 | 7 | 39 |
| 2020 Maio | 25 | 5 | 30 |
| 2020 Abril | 30 | 9 | 39 |
| 2020 Maro | 39 | 6 | 45 |
| 2020 Fevereiro | 27 | 10 | 37 |
| 2020 Janeiro | 24 | 4 | 28 |
| 2019 Dezembro | 24 | 7 | 31 |
| 2019 Novembro | 28 | 8 | 36 |
| 2019 Outubro | 42 | 3 | 45 |
| 2019 Setembro | 35 | 6 | 41 |
| 2019 Agosto | 27 | 5 | 32 |
| 2019 Julho | 41 | 11 | 52 |
| 2019 Junho | 32 | 7 | 39 |
| 2019 Maio | 35 | 9 | 44 |
| 2019 Abril | 23 | 14 | 37 |
| 2019 Maro | 31 | 9 | 40 |
| 2019 Fevereiro | 45 | 9 | 54 |
| 2019 Janeiro | 25 | 7 | 32 |
| 2018 Dezembro | 33 | 11 | 44 |
| 2018 Novembro | 66 | 7 | 73 |
| 2018 Outubro | 60 | 22 | 82 |
| 2018 Setembro | 16 | 12 | 28 |
| 2018 Agosto | 28 | 15 | 43 |
| 2018 Julho | 14 | 6 | 20 |
| 2018 Junho | 14 | 6 | 20 |
| 2018 Maio | 17 | 8 | 25 |
| 2018 Abril | 25 | 4 | 29 |
| 2018 Maro | 34 | 7 | 41 |
| 2018 Fevereiro | 6 | 7 | 13 |
| 2018 Janeiro | 15 | 6 | 21 |
| 2017 Dezembro | 38 | 14 | 52 |
| 2017 Novembro | 27 | 9 | 36 |
| 2017 Outubro | 16 | 8 | 24 |
| 2017 Setembro | 10 | 10 | 20 |
| 2017 Agosto | 28 | 14 | 42 |
| 2017 Julho | 20 | 7 | 27 |
| 2017 Junho | 26 | 7 | 33 |
| 2017 Maio | 34 | 9 | 43 |
| 2017 Abril | 20 | 3 | 23 |
| 2017 Maro | 15 | 6 | 21 |
| 2017 Fevereiro | 25 | 5 | 30 |
| 2017 Janeiro | 20 | 3 | 23 |
| 2016 Dezembro | 33 | 4 | 37 |
| 2016 Novembro | 21 | 7 | 28 |
| 2016 Outubro | 16 | 6 | 22 |
| 2016 Setembro | 24 | 9 | 33 |
| 2016 Agosto | 15 | 7 | 22 |
| 2016 Julho | 19 | 7 | 26 |
| 2016 Junho | 4 | 15 | 19 |
| 2016 Maio | 2 | 45 | 47 |
| 2016 Abril | 102 | 37 | 139 |
Mostrar tudo
