Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2022; 14(2): 96-107
Published online Feb 26, 2022. doi: 10.4330/wjc.v14.i2.96
Untangling the difficult interplay between ischemic and hemorrhagic risk: The role of risk scores
Simone Persampieri, Diego Castini, Alessandro Lupi, Marco Guazzi
Simone Persampieri, Alessandro Lupi, Division of Cardiology, Ospedale San Biagio, Verbania 28845, Italy
Diego Castini, Division of Cardiology, Ospedale San Paolo, Milan 20142, Italy
Diego Castini, Marco Guazzi, Department of Clinical Sciences, University of Milan, Milan 20122, Italy
Marco Guazzi, Division of Cardiology, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan 20142, Italy
Author contributions: Persampieri S and Castini D participated in the development of the proposal to research the topic, performed literature search and review, and wrote the draft of the manuscript, reviewed, edited and approved the manuscript; Lupi A and Guazzi M participated in the supervision of the research on the topic, reviewed, wrote and revised the manuscript as senior authors.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Simone Persampieri, MD, Doctor, Division of Cardiology, Ospedale San Biagio, Piazza Vittime dei Lager Nazifascisti 1, Verbania 28845, Italy. simone.persampieri@gmail.com
Received: May 17, 2021
Peer-review started: May 17, 2021
First decision: July 30, 2021
Revised: August 1, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: February 26, 2022
Processing time: 275 Days and 19.4 Hours
ARTICLE HIGHLIGHTS
Research background

Bleedingsare an independent risk factor for subsequent mortality in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention, representing a hazard equivalent to or greater than that for recurrent ACS. Dual antiplatelet therapy (DAPT) represents the cornerstone in the secondary prevention of thrombotic events, but the benefit of such therapy is counteracted by the increased hemorrhagic complications.

Research motivation

An early and individualized patient risk stratification can help to identify high-risk patients who could benefit the most from intensive medical therapies while minimizing unnecessary treatment complications in low-risk patients.

Research objectives

In order to review existing literature and gain better understanding of the role of ischemic and hemorrhagic risk scores in patients with ischemic heart disease (IHD).

Research methods

The authors used a combination of terms potentially used in the literature describing the most common ischemic and hemorrhagic risk scores to search in PubMed, as well as references of full-length articles. The authors briefly describe the most important ischemic and bleeding scores that can be adopted in patients with IHD, focusing on GRACE, CHA2DS2-Vasc, PARIS CTE, DAPT, CRUSADE, ACUITY (Mehran et al), HAS-BLED, PARIS MB and PRECISE-DAPT score.

Research results

A single score can’t be the real solution to balance the ischemic/bleeding risk of a patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD. In particular, we found that diabetes mellitus and vascular disease clearly increase the risk of ischemic events, while previous bleeding, anemia and CKD bring a high risk of further bleeding events. Some scores include too many variables that can mislead the clinician’s choice: since a perfect score could not exist we suggest the clinician apply the most user friendly and at the same time evaluate the cited variables separately. As suggested by Guidelines, PRECISE-DAPT could be the most suitable bleeding risk score, since it is more influenced by CKD, anemia and history of bleeding, while PARIS CTE should be the ischemic risk score of choice with diabetes mellitus and vascular disease.

Research conclusions

Risk scores by themselves can’t be the single solution to balance the ischemic/bleeding risk of an IHD patient. Instead, some risk factors that are commonly associated with an elevated risk profile and that are already included in risk scores should be the focus of the clinician while he/she is taking care of a patient affected by IHD.

Research perspectives

Future research should try to elaborate an omni-comprehensive score to be adopted in IHD and at the same time be easy to use and reliable.