Bleedng_in_ACS_SlideCAST.ppt

Accreditation Information Program Requirements Accreditation Information Accreditation Information ACS Forum Leadership Panel ACS Forum Leadership Panel ACS Forum Leadership Panel ACS Leadership Panel Financial Disclosures ACS Leadership Panel Financial Disclosures ACS Faculty Review Committee ACS Faculty Review Committee ACS Faculty Review Committee Educational Objectives Evolving Paradigm for Evaluating ACS Management Strategies Evolving Paradigm for Evaluating ACS Management Strategies Evolving Paradigm for Evaluating ACS Management Strategies Balancing Events and Bleeding CRUSADE In-Hospital Outcomes Bleeding in ACS - Agenda Predictors of bleeding in ACS Outcomes associated with bleeding Impact of definition on outcomes Outcomes associated with blood transfusion Special populations at risk Elderly Chronic kidney disease Anemia Cost implications of bleeding What predicts bleeding among patients with ACS ? Predictors of Major Bleeding in ACS Older Age Female Gender Renal Failure History of Bleeding Right Heart Catheterization GPIIb-IIIa antagonists Predictors of Major Bleeding REPLACE-2Multivariate Predictors of Major Bleeding Older age, chronic kidney disease, female gender are consistently associated with bleeding and blood transfusion Analysis of large randomized trials have also identified novel risk factors for bleeding such as diabetes and anemia Procedural characteristics such as procedure duration and sheath dwell time also predict bleeding complications Does bleeding influence the prognosis of ACS patients ? Bleeding Outcomes Bleeding and Outcomes in NSTE ACS Major Bleeding, Ischemic Endpoints, and Mortality Major Bleeding and Myocardial Infarction Major and Minor Bleeding in PCIBleeding Increases Mortality and Events Bleeding is associated with adverse short- and long-term outcomes among patients with ACS and those undergoing PCI Mortality rates are higher among those who bleed MI rates are higher among those who bleed The risk is “loss-