• 30‐days
• Dodoma
• first‐stroke
• mortality
• post‐stroke

• Blood-brain barrier
• Microglia
• Neuroinflammation
• Nicotine withdrawal
• PLX5622
• Sex differences

• R01 DA044311 NIDA NIH HHS
• R01 DA053070 NIDA NIH HHS

• Humans
• Ischemic Stroke
• Constriction, Pathologic
• Taiwan
• Stroke/etiology
• Stroke/therapy
• Intracranial Arteriosclerosis/complications
• Intracranial Arteriosclerosis/diagnosis
• Intracranial Arteriosclerosis/therapy

• Blood–brain barrier
• Cerebral blood flow
• Endothelial cells
• Metabolism
• Nicotine
• Sex difference

• Humans
• Vaping/adverse effects
• Electronic Nicotine Delivery Systems
• Nicotine/adverse effects
• Aerosols/adverse effects
• Brain Ischemia/etiology
• Stroke

• GLP-1
• IGF-1
• Immune dysregulation
• Intracerebral hemorrhage
• Neuroprotection

Spontaneous intracerebral hemorrhage (sICH) is a deadly stroke subtype, and tobacco use increases sICH risk. However epidemiological studies show that, there are no confirmatory studies showing the effect of tobacco use on sICH outcome. Therefore, we evaluated the effect of chronic nicotine exposure (as a surrogate for tobacco use) on outcomes following sICH. Young male and female rats were randomly assigned to either nicotine (4.5 mg/kg b.w. per day) or vehicle (saline) treatment (2–3 weeks) groups. sICH was induced by injecting collagenase into the right striatum. Neurological score and hematoma volume were determined 24 h post-sICH. The hematoma volumes in nicotine-treated male and female rats were significantly higher by 42% and 48% when compared to vehicle-treated male and female rats, respectively. Neurological deficits measured in terms of neurological score for the nicotine-treated male and female groups were significantly higher when compared to the respective vehicle-treated male and female groups. Our results show that chronic nicotine exposure increases hematoma volume post-sICH in rats of both sexes. Identifying the mechanism of nicotine-dependent increase in hematoma growth post-sICH will be crucial to understanding the detrimental effect of tobacco use on the severity of bleeding following intracerebral hemorrhage.

To quantify the association of cigarette smoking, including cigarettes per day and quitting duration, with the risk of different types of stroke morbidity and mortality in the general population, and to clarify the shape of the dose-response relations.

Prospective cohort studies and reported on the association between smoking, quitting and the incidence or mortality of stroke were included.

All available data were converted uniformly to odds ratios (ORs) and were pooled using random-effects meta-analysis with inverse variance weighting. A dose-response meta-analysis was performed to explore the quantitative relationship between different smoking characteristics and the risk of different pathologic types of stroke incidence.

Twenty-five studies with 3,734,216 individuals were included. Compared to never smokers, the pooled ORs of stroke morbidity and mortality were 1.45 (1.24–1.70) and 1.44 (1.23–1.67) among ever smokers and 1.90 (1.55–2.34) and 1.70 (1.45–1.98) among current smokers. The risk of different pathologic types of stroke was also increased among ever and current smokers. There was a significant non-linear dose-response association between the number of cigarette smoking and the risk of stroke incidence. Comparing no smoking, the ORs for smoking five and 35 cigarettes per day were 1.44 (1.35–1.53) and 1.86 (1.71–2.02). Other pathologic types of stroke have a similar dose-response relationship. There was also non-linear dose-response association between the length of time since quitting and risk of stroke. The risk of stroke decreased significantly after quitting for 3 years [OR = 0.56 (0.42–0.74)].

The risk of different types of stroke among smokers is remarkably high. Our findings revealed a more detailed dose-response relationship and have important implications for developing smoking control strategies for stroke prevention.

https://inplasy.com/inplasy-2020-6-0062/, identifier: INPLASY202060062.

• UL1 TR001863 NCATS NIH HHS
• Special Project for Research and Development in Key areas of Guangdong Province

• Cohort Study
• Japanese population
• Proportional hazards model
• Risk factor
• Smoking
• Stroke

• Cohort Studies
• Female
• Humans
• Japan/epidemiology
• Male
• Risk Factors
• Sex Distribution
• Smoking/adverse effects
• Stroke/epidemiology

• Black or African American/ethnology
• Black or African American/genetics
• Black or African American/statistics & numerical data
• Aged
• Case-Control Studies
• Cerebral Hemorrhage/epidemiology
• Cerebral Hemorrhage/ethnology
• Cerebral Hemorrhage/genetics
• Ethnic and Racial Minorities/statistics & numerical data
• Ethnicity/genetics
• Ethnicity/statistics & numerical data
• Female
• Genetic Predisposition to Disease
• Hispanic or Latino/genetics
• Hispanic or Latino/statistics & numerical data
• Humans
• Male
• Middle Aged
• Odds Ratio
• Race Factors/statistics & numerical data
• Risk Factors
• United States/epidemiology
• United States/ethnology
• White People/ethnology
• White People/genetics
• White People/statistics & numerical data

• T32 NS047996 NINDS NIH HHS
• UL1 TR001863 NCATS NIH HHS

• Sex differences
• Smoking
• Stroke
• Thrombectomy

Cerebrovascular disease (CVD) is the leading cause of death in many countries including China. Early diagnosis and risk assessment represent one of effective approaches to reduce the CVD-related mortality. The purpose of this study was to understand the prevalence and influencing factors of cerebrovascular disease among community residents in Qingyunpu District, Nanchang City, Jiangxi Province, and to construct a model of cerebrovascular disease risk index suitable for local community residents. A stratified cluster sampling method was used to sample 2147 community residents aged 40 and above, and the prevalence of cerebrovascular diseases and possible risk factors were investigated. It was found that the prevalence of cerebrovascular disease among local residents was 4.5%. Poisson regression analysis found that old age, lack of exercise, hypertension, diabetes, smoking, and family history of cerebrovascular disease are the main risk factors for local cerebrovascular disease. The relative risk ORs were 3.284, 2.306, 2.510, 3.194, 1.949, 2.315, respectively. For these six selected risk factors, a cerebrovascular disease risk prediction model was established using the Harvard Cancer Index method. The R value of the risk prediction model was 1.80 (sensitivity 81.8%, specificity 47.0%), which was able to well predict the risk of cerebrovascular disease among local residents. This provides a scientific basis for the further development of local cerebrovascular disease prevention and control work.

• cerebrovascular disease
• community residents
• risk factors
• risk prediction model

Spontaneous intracerebral hemorrhage (sICH) is one of the deadliest subtypes of stroke, and no treatment is currently available. One of the major risk factors is tobacco use. In this article, we review literature on how tobacco use affects the risk of sICH and also summarize the known effects of tobacco use on outcomes following sICH. Several studies demonstrate that the risk of sICH is higher in current cigarette smokers compared to non-smokers. The literature also establishes that cigarette smoking not only increases the risk of sICH but also increases hematoma growth, results in worse outcomes, and increases the risk of death from sICH. This review also discusses potential mechanisms activated by tobacco use which result in an increase in risk and severity of sICH. Exploring the underlying mechanisms may help alleviate the risk of sICH in tobacco users as well as may help better manage tobacco user sICH patients.

• Cerebral hemorrhage
• Hematoma
• Hemorrhagic stroke
• Risk factors
• Smoking
• Tobacco

• Blood pressure
• Coagulopathy reversal
• Hematoma
• Intracerebral hemorrhage
• Intraventricular hemorrhage
• Minimally invasive surgery

The purpose of this study was to verify the relationship between hematoma heterogeneity and hematoma expansion and explore any effect modifiers through subgroup analyses.

Clinical records of 357 patients with spontaneous cerebral hemorrhage at Shenzhen Second People’s Hospital from March 2016 to October 2018 were included in the study. Hematoma heterogeneity was measured on the first noncontrast computed tomography image according to the Barras scale. Hematoma expansion was defined as an absolute hematoma volume increase of 6 mL, or a 33% increase. We performed univariate and multivariate logistic regression analyses, as well as subgroup analyses, to assess the relationship between the presence of heterogeneity on noncontrast computed tomography and hematoma expansion.

Hematoma expansion occurred in 79 (22.13%) of the 357 patients with intracerebral hemorrhage (ICH). Among the patients with ICH, there were 83 smokers, accounting for 23.24%. The average patient age was 56.21 ± 13.75 years, and 74.51% were male. Compared with the absence of heterogeneity, the risk of hematoma expansion increased by 1.06 times (odds ratio, 2.06; 95% confidence interval, 1.10–3.86). Based on the subgroup analysis, smoking status was found to modify the association between heterogeneity and hematoma expansion; the association was stronger in smokers than in nonsmokers (odds ratio, 10.23; 95% confidence interval, 2.15–48.65).

Heterogeneity independently predicts hematoma expansion, especially in smoking patients.

• CI, Confidence interval
• CT, Computed tomography
• DBP, Diastolic blood pressure
• Hematoma expansion
• Hematoma heterogeneity
• ICH, Intracerebral hemorrhage
• IQR, Interquartile range
• Intracerebral hemorrhage
• OR, Odds ratio
• Smoking

• Bleeding
• Cerebral arteriovenous malformations
• Risk
• Smoking

While the relationship between hypertension and incident intracerebral haemorrhage is well established, other risk factors are less clear. This study examined risk factors for primary intracerebral haemorrhage, separately for lobar and non-lobar intracerebral haemorrhage.

Incidence of intracerebral haemorrhage was studied among 28,416 individuals from the population-based Malmö Diet and Cancer cohort. Intracerebral haemorrhage cases were ascertained using the Swedish Hospital Discharge Register and the Stroke Register of Malmö, validated by review of hospital records and images, and classified by location by a neuroradiologist. Multivariable Cox regression was used.

Three hundred and thirty-three intracerebral haemorrhages occurred, mean follow-up time was 18.4 years. Systolic blood pressure (hazard ratio per 10 mmHg 1.19 [95% confidence interval 1.13–1.26], diastolic blood pressure (hazard ratio 1.42 [1.27–1.59]), oral anticoagulants (hazard ratio 4.26 [2.17–8.38]), smoking (hazard ratio 1.45 [1.14–1.87]), living alone (hazard ratio 1.32 [1.04–1.69]) and low apolipoprotein B (hazard ratio per 10 mg/dL: 0.94 [0.90–0.99]) were significantly associated with incident intracerebral haemorrhage after multivariable adjustment. Systolic blood pressure, smoking and oral anticoagulants were associated with lobar intracerebral haemorrhage. Systolic blood pressure, diastolic blood pressure, living alone and diabetes were associated with non-lobar intracerebral haemorrhage. Diabetes and diastolic blood pressure showed significantly different relationships with lobar and non-lobar intracerebral haemorrhage. Alcohol, apolipoprotein A1, body mass index, waist circumference, physical activity and education were not independently associated with intracerebral haemorrhage.

Discussion and conclusions: Blood pressure, smoking, low apolipoprotein B, oral anticoagulants and living alone were associated with intracerebral haemorrhage. Diabetes was associated with non-lobar intracerebral haemorrhage only. Further research is required on differences between lobar and non-lobar intracerebral haemorrhage.

• Intracerebral haemorrhage
• epidemiology
• intracranial haemorrhage
• risk factors
• stroke

• Antithrombotic
• Intracranial hemorrhage
• Ischemic stroke

• Intracerebral hemorrhage
• functional independence
• morbidity
• outcomes
• smoking
• stroke
• survival

• CT
• Hematoma
• Spontaneous intracerebral hemorrhage
• Stroke
• Support vector machine

• Adult
• Aged
• Aged, 80 and over
• Biomarkers
• Cerebral Hemorrhage/diagnosis
• Cerebral Hemorrhage/etiology
• Cerebral Hemorrhage/metabolism
• Female
• Glasgow Coma Scale
• Hematoma/complications
• Hematoma/metabolism
• Hematoma/pathology
• Humans
• Image Processing, Computer-Assisted
• Male
• Middle Aged
• Models, Biological
• Odds Ratio
• Prognosis
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity
• Support Vector Machine
• Tomography, X-Ray Computed
• Young Adult

• bleed
• cigarette
• inflammation
• nicotine
• smoking
• stroke

• Adult
• Aged
• Aged, 80 and over
• Cerebral Hemorrhage/epidemiology
• Cerebral Hemorrhage/mortality
• Cerebral Hemorrhage/therapy
• Cigarette Smoking/epidemiology
• Cohort Studies
• Ethnicity
• Female
• Health Status
• Hispanic or Latino
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Prospective Studies
• Quality of Life
• Treatment Outcome
• White People

• R01 NS030678 NINDS NIH HHS
• U01 NS069763 NINDS NIH HHS
• R01 NS036695 NINDS NIH HHS
• U01 NS036695 NINDS NIH HHS
• RF1 NS036695 NINDS NIH HHS

• meta-analysis
• smoking
• stroke

• Dose-Response Relationship, Drug
• Humans
• Odds Ratio
• Risk Assessment
• Risk Factors
• Sex Factors
• Smokers/statistics & numerical data
• Smoking/epidemiology
• Stroke/classification
• Stroke/epidemiology
• Tobacco Smoke Pollution/statistics & numerical data

• epidemiology
• risk factors
• smoking
• stroke

• Adult
• Age Factors
• Aged
• China/epidemiology
• Cross-Sectional Studies
• Female
• Humans
• Male
• Middle Aged
• Prevalence
• Risk Assessment
• Risk Factors
• Sex Factors
• Smoking/epidemiology
• Smoking Cessation/statistics & numerical data
• Stroke/epidemiology
• Survivors/statistics & numerical data

• Nonvalvular atrial fibrillation
• Smoking
• Transesophageal echocardiography

The CD36 gene encodes a membrane glycoprotein (type B scavenger receptor, SR-B2) that plays a crucial role in lipid sensing, innate immunity, atherogenesis, and glycolipid metabolism. In this study, we aimed to investigate the association between CD36 gene polymorphisms and intracerebral hemorrhage (ICH) in a Han Chinese population. We performed genotype and allele analyses for eleven single nucleotide polymorphisms (SNPs) of CD36 in a case-controlled study involving 292 ICH patients and 298 control participants. Eleven SNPs were genotyped by the Improved Multiple Ligase Detection Reaction (iMLDR) method. The results indicated that the SNP rs1194182 values were significantly different between ICH group and control group in a dominant model after adjusting for confounding factors. The subgroup analysis conducted for rs1194182 showed that the allele G frequencies were significantly different between ICH patients and controls in hypertension group via a dominant model. We then analyzed the rs1194182 genotype distributions among different groups of the serum lipid groups, including BMI, TC, TG, HDL, and LDL. However, no significant differences were found in the analysis of other subgroups. Taken together, these findings indicate that rs1194182 polymorphism in the CD36 gene was associated with ICH, and genotype GG could be an independent predictor.

• Cardiovascular diseases
• Korea
• Korea Community Health Survey
• Passive smoking
• Smoking

• Adult
• Bayes Theorem
• Cardiovascular Diseases/epidemiology
• Female
• Health Surveys
• Humans
• Male
• Middle Aged
• Republic of Korea/epidemiology
• Risk Factors
• Smoking/adverse effects
• Smoking/epidemiology
• Tobacco Smoke Pollution/adverse effects
• Tobacco Smoke Pollution/statistics & numerical data

• Epidemiology
• Lifestyle
• Stroke outcomes

• Alcohol Drinking/epidemiology
• Body Mass Index
• Brain Ischemia/epidemiology
• Brain Ischemia/physiopathology
• Diet, Healthy
• Exercise
• Female
• Healthy Lifestyle
• Humans
• Intracranial Hemorrhages/epidemiology
• Intracranial Hemorrhages/physiopathology
• Middle Aged
• Obesity/epidemiology
• Odds Ratio
• Protective Factors
• Risk Factors
• Severity of Illness Index
• Smoking/epidemiology
• Stroke/epidemiology
• Stroke/physiopathology

• R01 HL043851 NHLBI NIH HHS
• UM1 CA182913 NCI NIH HHS
• R01 CA047988 NCI NIH HHS
• R01 HL080467 NHLBI NIH HHS
• RC1 HL099355 NHLBI NIH HHS

Previous studies on the association between coffee consumption and subarachnoid hemorrhage (SAH) have provided inconsistent results. We examine the risk of SAH from coffee consumption in a Japanese population.

Our analyses were based on the Jichi Medical School Cohort Study, a large-scale population-based prospective cohort study. A total of 9941 participants (3868 men and 6073 women; mean age 55 years) with no history of cardiovascular disease or carcinoma were examined. Participants were asked to choose one of five options to indicate their daily coffee consumption: none, less than 1 cup a day, 1–2 cups a day, 3–4 cups a day, or 5 or more cups a day. The incidence of SAH was assessed independently by a diagnostic committee. Cox proportional hazards models were used to calculate hazard ratios (HRs) and their 95% confidence intervals (CI) after adjustment for age and sex (HR1) and for additional potential confounders (HR2).

During 10.7 years of follow-up, SAH occurred in 47 participants. When compared with the participants who consumed less than 1 cup of coffee a day, the HR of SAH was significantly higher in the group who consumed 5 or more cups a day in both models (HR1 4.49; 95% CI, 1.44–14.00; HR2 3.79; 95% CI, 1.19–12.05).

The present community-based cohort study showed that heavy coffee consumption was associated with an increased incidence of SAH after adjusting for age, sex, and multiple potential cardiovascular confounders.

• AHA Scientific Statements
• blood pressure
• coagulopathy
• diagnosis
• intracerebral hemorrhage
• intraventricular hemorrhage
• surgery
• treatment

• American Heart Association
• Cerebral Hemorrhage/diagnosis
• Cerebral Hemorrhage/epidemiology
• Cerebral Hemorrhage/therapy
• Disease Management
• Health Personnel/standards
• Humans
• Stroke/diagnosis
• Stroke/epidemiology
• Stroke/therapy
• United States/epidemiology

Intracerebral hemorrhage (ICH) is a very complex pathology, with many different not fully elucidated etiologies and prognostics. It is the most severe subtype of stroke, with high mortality and morbidity rates. Unfortunately, despite the numerous promising preclinical assays including neuroprotective, anti-hypertensive, and anti-inflammatory drugs, to this moment only symptomatic treatments are available, motivating the search for new alternatives. In this context, stem cell therapy emerged as a promising tool. However, more than a decade has passed, and there is still much to be learned not only about stem cells, but also about ICH itself, and how these two pieces come together. To date, rats have been the most widely used animal model in this research field, and there is much more to be learned from and about them. In this review, we first summarize ICH epidemiology, risk factors, and pathophysiology. We then present different methods utilized to induce ICH in rats, and examine how accurately they represent the human disease. Next, we discuss the different types of stem cells used in previous ICH studies, also taking into account the tested transplantation sites. Finally, we summarize what has been achieved in assays with stem cells in rat models of ICH, and point out some relevant issues where attention must be given in future efforts.

• Cell therapy
• Intracerebral hemorrhage
• Preclinical assays
• Rat
• Stem cells

To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in stroke patients, and to assess the difference in swallowing function between stroke patients with COPD (COPD group) and stroke patients without COPD (control group).

The subjects included 103 stroke patients. They underwent the pulmonary function test and were assigned to either the COPD group or the control group. Their penetration-aspiration scale (PAS) scores and functional dysphagia scale scores were compared by performing a videofluoroscopic swallowing study. The intergroup differences in lip closure, bolus formation, mastication, and the oral transit time, laryngeal elevation, cricopharyngeal dysfunction, oronasal regurgitation, residue in pyriform sinus and vallecula, pharyngeal transit time, aspiration, and esophageal relaxation were also compared.

Thirty patients were diagnosed with COPD. The COPD group showed statistically higher PAS scores (4.67±2.15) compared to the control group (2.89±1.71). Moreover, aspiration occurred more frequently in the COPD group with statistical significance (p<0.05). The COPD group also showed higher occurrence of cricopharyngeal dysfunction, albeit without statistical significance.

This study shows that a considerable number of stroke patients had COPD, and stroke patients with COPD had higher risk of aspiration than stroke patients without COPD.

• Chronic obstructive pulmonary disease (COPD)
• Deglutition disorders
• Respiratory aspiration
• Stroke

• AHA Scientific Statements
• atrial fibrillation
• diabetes mellitus
• hyperlipidemias
• hypertension
• intracranial aneurysm
• ischemia
• prevention and control
• smoking
• stroke

• American Heart Association
• Evidence-Based Medicine
• Humans
• Primary Prevention/methods
• Risk Factors
• Stroke/prevention & control
• United States

• R01 NS034179 NINDS NIH HHS
• U01 NS069208 NINDS NIH HHS

• Nonvalvular atrial fibrillation
• Prognosis
• Smoking

• Glasgow outcome scale
• Hematoma drainage
• Intracerebral hemorrhage
• Neuronavigation
• Prognostic factors

Cerebral microbleeds (microbleeds) are small, punctuate hypointense lesions seen in T2* Gradient-Recall Echo (GRE) and Susceptibility-Weighted (SWI) Magnetic Resonance Imaging (MRI) sequences, corresponding to areas of hemosiderin breakdown products from prior microscopic hemorrhages. They occur in the setting of impaired small vessel integrity, commonly due to either hypertensive vasculopathy or cerebral amyloid angiopathy. Microbleeds are more prevalent in individuals with Alzheimer’s disease (AD) dementia and in those with both ischemic and hemorrhagic stroke. However they are also found in asymptomatic individuals, with increasing prevalence with age, particularly in carriers of the Apolipoprotein (APOE) ε4 allele. Other neuroimaging findings that have been linked with microbleeds include lacunar infarcts and white matter hyperintensities on MRI, and increased cerebral β-amyloid burden using ¹¹C-PiB Positron Emission Tomography. The presence of microbleeds has been suggested to confer increased risk of incident intracerebral hemorrhage – particularly in the setting of anticoagulation – and of complications of immunotherapy for AD. Prospective data regarding the natural history and sequelae of microbleeds are currently limited, however there is a growing evidence base that will serve to inform clinical decision-making in the future.

• Alzheimer’s disease
• MRI imaging
• amyloid imaging
• cerebral amyloid angiopathy
• intracerebral hemorrhage
• microbleeds
• positron-emission tomography
• stroke

Stroke was the second most common cause of death worldwide in 2004, resulting in 5.7 million deaths. This case controlled study was conducted in Tertiary care hospitals of Peshawar, KPK Pakistan about common risk factors of stroke and the impact of these risk factors.

Study was done at Government Tertiary Care Hospitals of Peshawar namely Khyber Teaching Hospital (KTH), Lady Reading Hospital (LRH) and Hayatabad Medical Complex (HMC).The hospital based case–control study included 50 cases (stroke patients) and 100 controls (non-stroke patients). This study was accomplished from 24th April 2012 to October 2012 in tertiary care hospitals of Peshawar. A proper questionnaire was used to collect data from all the cases and controls, which was recorded in the form of tables and graphs. The risk factors studied were Hypertension, Smoking, diabetes, sedentary lifestyle, cardiac problems, B.M.I, diet, stress and family history of stroke. Anthropometric (weight, height, body mass index) measurements were done on all patients. For determination of association and impact of these risk factors, analyses were performed by calculation of Chi-Square test and confidence interval using SPSS version 16 program.

Comparing the cases with controls, hypertension (p = 0.000), sedentary life style (p = 0.000), cardiac problems (p = 0.009), diabetes mellitus (p = 0.010), smoking (p = 0. 042) were significant risk factors whereas B.M.I (p = 0. 393), stress (p = 0.705), family history of stroke (p = 0.729), diet (p = 0.908), were not found to be statistically significant risk factors. The most significant risk factor was systemic hypertension (OR = 4.16) followed by sedentary life style (OR = 3.60), cardiac problems (OR = 2.74) diabetes (OR = 2.49) and smoking (OR = 2.05).

Hypertension, Smoking, diabetes, sedentary lifestyle and cardiac problems have strong correlations and association with Stroke and are the major risk factors of stroke. Prevention of these risk factors can lead to decrease in the incidence of stroke. B.M.I, diet, stress and family history of stroke had no significant association.

AIM: To derive and validate a score for the prediction of mid-term bleeding events following discharge for myocardial infarction (MI).

METHODS: One thousand and fifty patients admitted for MI and followed for 19.9 ± 6.7 mo were assigned to a derivation cohort. A new risk model, called BLEED-MI, was developed for predicting clinically significant bleeding events during follow-up (primary endpoint) and a composite endpoint of significant hemorrhage plus all-cause mortality (secondary endpoint), incorporating the following variables: age, diabetes mellitus, arterial hypertension, smoking habits, blood urea nitrogen, glomerular filtration rate and hemoglobin at admission, history of stroke, bleeding during hospitalization or previous major bleeding, heart failure during hospitalization and anti-thrombotic therapies prescribed at discharge. The BLEED-MI model was tested for calibration, accuracy and discrimination in the derivation sample and in a new, independent, validation cohort comprising 852 patients admitted at a later date.

RESULTS: The BLEED-MI score showed good calibration in both derivation and validation samples (Hosmer-Lemeshow test P value 0.371 and 0.444, respectively) and high accuracy within each individual patient (Brier score 0.061 and 0.067, respectively). Its discriminative performance in predicting the primary outcome was relatively high (c-statistic of 0.753 ± 0.032 in the derivation cohort and 0.718 ± 0.033 in the validation sample). Incidence of primary/secondary endpoints increased progressively with increasing BLEED-MI scores. In the validation sample, a BLEED-MI score below 2 had a negative predictive value of 98.7% (152/154) for the occurrence of a clinically significant hemorrhagic episode during follow-up and for the composite endpoint of post-discharge hemorrhage plus all-cause mortality. An accurate prediction of bleeding events was shown independently of mortality, as BLEED-MI predicted bleeding with similar efficacy in patients who did not die during follow-up: Area Under the Curve 0.703, Hosmer-Lemeshow test P value 0.547, Brier score 0.060; low-risk (BLEED-MI score 0-3) event rate: 1.2%; intermediate risk (score 4-6) event rate: 5.6%; high risk (score ≥ 7) event rate: 12.5%.

CONCLUSION: A new bedside prediction-scoring model for post-discharge mid-term bleeding has been derived and preliminarily validated. This is the first score designed to predict mid- term hemorrhagic risk in patients discharged following admission for acute MI. This model should be externally validated in larger cohorts of patients before its potential implementation.

• Myocardial infarction
• Bleeding
• Prediction model
• Risk stratification

• hemorrhagic
• mortality
• smoking
• stroke

• carotid atherosclerotic plaque
• enzyme-linked immunosorbent assay
• monocyte chemoattractant protein
• serum protein levels
• vascular endothelial growth factor