{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:25:25Z","timestamp":1793831125517,"version":"4.6.1"},"reference-count":46,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,5]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Bleeding risk stratification in acute coronary syndrome is of highest clinical interest but current risk scores have limitations. We sought to develop and validate a new in\u2010hospital bleeding risk score for patients with acute myocardial infarction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              From the nationwide\n              <jats:styled-content style=\"fixed-case\">SWEDEHEART<\/jats:styled-content>\n              (Swedish Web\u2010System for Enhancement and Development of Evidence\u2010Based Care in Heart Disease Evaluated According to Recommended Therapies) register, 97,597 patients with acute myocardial infarction enrolled from 2009 until 2014 were selected. A full model with 23 predictor variables and 8 interaction terms was fitted using logistic regression. The full model was approximated by a model with 5 predictors and 1 interaction term. Calibration, discrimination, and clinical utility was evaluated and compared with the\n              <jats:styled-content style=\"fixed-case\">ACTION<\/jats:styled-content>\n              (Acute Coronary Treatment and Intervention Outcomes Network) and\n              <jats:styled-content style=\"fixed-case\">CRUSADE<\/jats:styled-content>\n              (Can Rapid Risk Stratification of Unstable Angina Patients Suppress\n              <jats:styled-content style=\"fixed-case\">Ad<\/jats:styled-content>\n              verse Outcomes With Early Implementation of the\n              <jats:styled-content style=\"fixed-case\">ACC<\/jats:styled-content>\n              \/AHA Guidelines) scores. Internal and temporal validity was assessed. In\u2010hospital major bleeding, defined as fatal, intracranial, or requiring surgery or blood transfusion, occurred in 1356 patients (1.4%). The 5 predictors in the approximate model that constituted the\n              <jats:styled-content style=\"fixed-case\">SWEDEHEART<\/jats:styled-content>\n              score were hemoglobin, age, sex, creatinine, and C\u2010reactive protein. The\n              <jats:styled-content style=\"fixed-case\">ACTION<\/jats:styled-content>\n              and\n              <jats:styled-content style=\"fixed-case\">CRUSADE<\/jats:styled-content>\n              scores were poorly calibrated in the derivation cohort and therefore were recalibrated. The\n              <jats:styled-content style=\"fixed-case\">SWEDEHEART<\/jats:styled-content>\n              score showed higher discriminative ability than both recalibrated scores, overall (\n              <jats:italic>C<\/jats:italic>\n              \u2010index 0.80 versus 0.73\/0.72) and in all predefined subgroups. Decision curve analysis demonstrated consistently positive and higher net benefit for the\n              <jats:styled-content style=\"fixed-case\">SWEDEHEART<\/jats:styled-content>\n              score compared with both recalibrated scores across all clinically relevant decision thresholds. The original\n              <jats:styled-content style=\"fixed-case\">ACTION<\/jats:styled-content>\n              and\n              <jats:styled-content style=\"fixed-case\">CRUSADE<\/jats:styled-content>\n              scores showed negative net benefit.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The 5\u2010item\n              <jats:styled-content style=\"fixed-case\">SWEDEHEART<\/jats:styled-content>\n              score discriminates in\u2010hospital major bleeding in patients with acute myocardial infarction and has superior model performance compared with the recalibrated\n              <jats:styled-content style=\"fixed-case\">ACTION<\/jats:styled-content>\n              and\n              <jats:styled-content style=\"fixed-case\">CRUSADE<\/jats:styled-content>\n              scores.\n            <\/jats:p>\n          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