Regular ArticleCRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention
Introduction
Major bleeding events are associated with worse outcomes in patients with acute coronary syndromes (ACS) [1], [2], [3]. Bleeding risk assessment in this clinical scenario is much more limited than ischemic risk stratification. Most of the few existing predictive models of bleeding in ACS [4], [5] have been derived from populations included in clinical trials in which high-risk patients are clearly underrepresented and prevalence of comorbidities is usually low. In contrast, the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) bleeding risk score [6] (CBRS) was developed in a broad population of community treated non-ST segment elevation myocardial infarction (NSTEMI) patients and showed an accurate predictive power of major bleeding in patients with NSTEMI, and has become one of the most important tools for bleeding risk stratification in this clinical scenario. However, little information exists about its application in patients with ST segment elevation myocardial infarction (STEMI). Therefore, the aim of this study was a) to assess baseline characteristics and overall bleeding risk in a cohort of non-selected STEMI patients undergoing primary percutaneous coronary intervention (PCI) and b) to assess the ability of CBRS to predict major in-hospital bleeding non related to surgery in this clinical setting.
Section snippets
Study Design and Population
All consecutive patients admitted to the Coronary Care Unit of our center with diagnosis of STEMI and undergoing primary PCI between October 2009 and April 2012 were prospectively included. Afterwards, patients under chronic anticoagulant treatment and patients with missing CBRS values were excluded from the analysis. Informed consent was given by all patients before their inclusion. Confidential information of the patients was protected according to national normative. The study protocol was
Results
Of a population of 1177 consecutive patients treated with primary PCI we included 1064 patients. We excluded 24 (2%) patients on chronic oral anticoagulation, and 93 (7.9%) with missing data on CBRS.
Discussion
Tha main findings of our study were: a) our population of non selected STEMI patients undergoing primary PCI had lower overall bleeding risk than CRUSADE NSTEMI population; b) the CBRS had a good performance in this different clinical scenario and c) major CRUSADE in-hospital bleeding events was associated with a significantly higher mid term mortality in or series.
Bleeding risk assessment in patients with ACS is much more limited than ischemic risk stratification [14], [15], [16]. The CBRS [6]
Conflict of Interest Statement
There are no conflicts of interest regarding this paper.
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