Bleed-myocardial infarction score: predicting mid-term post-discharge bleeding events

Purpose: Prediction of hemorrhagic events in the acute/sub-acute phases of a Myocardial Infarction (MI) has already been addressed before. However, prediction of mid- to long-term bleeding has received scarce attention. We aim at deriving and validating a score for the prediction of mid-term bleeding events following discharge for MI. Methods: 917 patients admitted for MI and followed for 19.9±6.7 months 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), incorporating the following variables: Age, Diabetes Mellitus, arterial hypertension, smoking habits, urea, creatinine clearance and hemoglobin at admission, history of stroke, bleeding during hospitalization or previous major bleeding and heart failure during hospitalization. The BLEED-MI model was tested for calibration, accuracy and discrimination in the derivation sample and in a new, independent, validation cohort comprising 798 patients admitted at a later date. Results: The BLEED-MI score showed good calibration in both derivation and validation samples (Hosmer-Lemeshow test p-value 0.350 and 0.514, respectively) and high accuracy within each individual patient (Brier score 0.060 and 0.066, respectively). Its discriminative performance in predicting the primary outcome was relatively high (c-statistic of 0.751±0.031 in the derivation cohort and 0.720±0.036 in the validation sample). Incidence of primary/secondary endpoints increased 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 endpoint of post-discharge hemorrhage plus all-cause mortality. Conclusions: 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 cohorts of patients before its potential clinical implementation.