Elsevier

Thrombosis Research

Volume 132, Issue 6, December 2013, Pages 652-658
Thrombosis Research

Regular Article
CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention

https://doi.org/10.1016/j.thromres.2013.09.019Get rights and content

Abstract

Introduction

The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).

Materials and Methods

We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC).

Results

We included 1064 patients (mean age 63 years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n = 621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344 days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001).

Conclusions

Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.

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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