Validation of Bleeding Classifications in Coronary Artery Bypass Grafting

Debora Brascia, D. Reichart, F. Onorati, A. Perrotti, Vito G. Ruggieri, K. Bounader, J.P. Verhoye, G. Santarpino, T. Fischlein, D. Maselli, C. Dominici, G. Mariscalco, R. Gherli, A.S. Rubino, M. De Feo, C. Bancone, G. Gatti, F. Santini, M. Dalén, M. SaccocciG. Faggian, T. Tauriainen, E.-M. Kinnunen, F. Nicolini, T. Gherli, S. Rosato, F. Biancari

Research output: Contribution to journalArticlepeer-review


Perioperative bleeding is a determinant of poor outcome in patients undergoing coronary artery bypass grafting (CABG), but there is a lack of adequate stratification of its severity. The ability of the European registry of Coronary Artery Bypass Grafting (E-CABG), Universal Definition of Perioperative Bleeding (UDPB), Study of Platelet Inhibition and Patient Outcomes (PLATO), Clopidogrel and Aspirin Optimal Dose Usage to Reduce Recurrent Events−Seventh Organization to Assess Strategies in Ischemic Syndromes (CURRENT-OASIS 7), Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q Wave Coronary Events (ESSENCE), and SafeTy and Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an internationaL randomized Evaluation (STEEPLE) bleeding classifications to predict early mortality, stroke, acute kidney injury (AKI) stage 3, and deep sternal wound infection/mediastinitis was investigated in 3,730 patients from the prospective, multicentre E-CABG registry. Increasing grades of the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 classifications were associated with increasing risks of early mortality, had similar receiver-operating characteristic area under the curves (>0.7), and were predictive also when adjusted for EuroSCORE II. The E-CABG and UDPB classifications had satisfactory area under the curves (>0.6) in predicting stroke, AKI stage 3, and deep sternal wound infection/mediastinitis even when adjusted for EuroSCORE II. The PLATO and CURRENT-OASIS 7 classifications had similar predictive ability for stroke and AKI stage 3 as confirmed by multivariate analysis adjusted for EuroSCORE II but showed inferior ability in predicting severe wound infection compared to the E-CABG and UDPB classifications. The STEEPLE and ESSENCE classifications had a poor ability of predicting all these adverse events. Decision curve analysis showed a benefit of the E-CABG bleeding classification over the other classifications in predicting all adverse events. In conclusion, the E-CABG, UDPB, PLATO, and CURRENT-OASIS 7 bleeding classifications have a satisfactory ability in predicting adverse events after CABG. Decision curve analysis showed that the E-CABG bleeding classification had the best predictive performance. © 2016 Elsevier Inc.
Original languageEnglish
Pages (from-to)727-733
Number of pages7
JournalAmerican Journal of Cardiology
Issue number5
Publication statusPublished - 2017


  • acute kidney failure
  • aged
  • area under the curve
  • Article
  • bleeding
  • cerebrovascular accident
  • coronary artery bypass graft
  • disease classification
  • EuroSCORE
  • female
  • human
  • major clinical study
  • male
  • mediastinitis
  • mortality
  • perioperative period
  • priority journal
  • prospective study
  • receiver operating characteristic
  • register
  • surgical risk
  • treatment outcome
  • wound infection
  • Acute Kidney Injury
  • classification
  • Coronary Stenosis
  • mammary artery
  • middle aged
  • multivariate analysis
  • peroperative complication
  • postoperative hemorrhage
  • procedures
  • risk factor
  • severity of illness index
  • statistical model
  • Stroke
  • transplantation
  • validation study
  • anticoagulant agent
  • antithrombocytic agent
  • Aged
  • Anticoagulants
  • Coronary Artery Bypass
  • Female
  • Hemorrhage
  • Humans
  • Intraoperative Complications
  • Logistic Models
  • Male
  • Mammary Arteries
  • Middle Aged
  • Multivariate Analysis
  • Platelet Aggregation Inhibitors
  • Postoperative Hemorrhage
  • Prospective Studies
  • Registries
  • Risk Factors
  • ROC Curve
  • Severity of Illness Index


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