CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Risk Stratification

Background:

• The CRUSADE bleeding risk score (CBRS) is established for predicting major bleeding in non-ST-segment elevation myocardial infarction (NSTEMI).
• Its utility in ST-segment elevation myocardial infarction (STEMI) patients, particularly those undergoing primary percutaneous coronary intervention (PPCI), is less understood.

Purpose of the Study:

• To evaluate the predictive accuracy of the CBRS for in-hospital major bleeding in STEMI patients undergoing PPCI.
• To assess the CBRS performance across different risk strata and patient subgroups, including those with radial access.

Main Methods:

• Prospective analysis of 1064 consecutive STEMI patients undergoing PPCI.
• Major bleeding defined by the CRUSADE criteria.
• Logistic regression and Area Under the Receiver Operating Characteristic Curve (AUC) used to assess predictive ability.

Main Results:

• The mean CBRS was 24, with most patients in lower risk quintiles.
• In-hospital major bleeding occurred in 3.1% of patients (33/1064).
• The CBRS demonstrated strong predictive ability (AUC = 0.80), with similar performance in radial access patients (AUC = 0.81).
• Higher bleeding rates were observed across increasing CBRS risk quintiles (p < 0.001).
• Bleeding events were associated with significantly higher follow-up mortality (HR 6.91, p < 0.001).

Conclusions:

• STEMI patients undergoing PPCI in this cohort exhibited lower bleeding risk compared to the NSTEMI population in the CRUSADE study.
• The CBRS is an accurate tool for predicting major in-hospital bleeding in STEMI patients undergoing PPCI, including those treated with radial access.
• The CBRS provides valuable risk stratification, identifying patients at higher risk of bleeding and subsequent mortality.