Bleeding Predictor in ST-Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Infarction: The Indonesian (INA) Bleeding Risk Score

Background Acute myocardial infarction still become one of the leading mortality cause in the world. Among these patients, ST elevation myocardial infartion (STEMI) has the greatest mortality rate among other type of Myocardial Infarction. When a myocard infarct patient have bleeding events, mortality rate greatly increased. Up until now, there is no specific bleeding risk assessment tool to predict bleeding events in STEMI patient. Methods A retrospective cohort study, done in National Cardiovascular Center Harapan Kita, Jakarta in STEMI patients underwent Primary Percutaneous Coronary Intervention (PPCI). Bleeding event was defined according to definition by Bleeding Academic Research Consortium (BARC) European Society of Cardiology, 2011. Categories for data obtained was basic characteristics, clinical examinations, initial therapies, lab results, x-ray, PPCI procedures, and in hospital treatments. Statistical analysis was done using multivariat analysis using logistic regression method and then converted to a scoring system. Results 579 sampels fit the inclusion and exclusion criteria. Bleeding event occured in 42 patients (7.3%). Indonesia bleeding score (Range 1-100) was created by assignment of variables that included in the final model according to their Odds Ratio (OR) values. Those variables are: female gender (OR 2.91, CI 1.23-6.91), Killip class 3 / 4 (OR 5.64, CI 2.27-14.03), Age ? 62 y.o (OR 2.19, CI 1.00-4.83), White blood cell >12.000 (OR 2.12, CI 0.95-4.73), Creatinine >1.5 (OR 2.17, CI 0.95-4.96), Body Mass Index ? 25 (OR 1.71, CI 0.83-3.51), Multiple coronary lesion (OR 1.95, CI 0.83- 4.54), Femoral access (OR 2.33, CI 0.77-7.01), and TPM implantation (OR 3.21, CI 1.28-8.07). These variabels was converted into two type of scoring system. The INA-1 contains all of the variables, and INA-2 minus variables related to interventional result and procedures. Conclusion Indonesia bleeding score quantifies risk for in-hospital bleeding event in STEMI patients underwent PPCI, which enhances baseline risk assessment for STEMI care