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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Evaluation of the CRUSADE Risk Score for Predicting Major Bleeding in Patients with Concomitant Kidney Dysfunction
Marianela Sánchez-Martínez1, Pedro J Flores-Blanco1, Ángel A López-Cuenca2
1Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain.
Insights
The CRUSADE risk score is less accurate in predicting major bleeding in acute coronary syndrome patients with kidney dysfunction. This highlights a need for improved risk assessment in this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Clinical Risk Stratification
Background:
- Kidney dysfunction (KD) increases major bleeding (MB) risk in acute coronary syndromes (ACS).
- Underuse of evidence-based therapies may contribute to this increased risk.
- The CRUSADE risk score is used for risk stratification in ACS patients.
Purpose of the Study:
- To assess the predictive ability of the CRUSADE risk score for major bleeding in ACS patients with concurrent chronic kidney disease.
Main Methods:
- Retrospective analysis of 1,587 ACS patients from a prospective registry.
- In-hospital MB prospectively recorded using CRUSADE and Bleeding Academic Research Consortium (BARC) criteria.
- KD defined as estimated glomerular filtration rate <60 mL/min/1.73 m².
Main Results:
- 29% of subjects had KD.
- High CRUSADE scores associated with higher in-hospital MB, but not BARC MB in KD patients.
- CRUSADE score predictive ability was lower in KD patients (AUC 0.71 vs. 0.79 for CRUSADE MB; AUC 0.65 vs. 0.75 for BARC MB).
Conclusions:
- The CRUSADE risk score demonstrates reduced accuracy in predicting in-hospital major bleeding for patients with kidney dysfunction compared to those without KD.
Background:
Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease.
Methods:
We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2.
Results:
The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, p = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, p = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all p values >0.3).
Conclusions:
The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.
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