Predictive Validity of CRUSADE, ACTION and ACUITY-HORIZONS Bleeding Risk Scores in Chinese Patients With ST-Segment...

Area of Science:

• Cardiology
• Clinical Research
• Medical Informatics

Background:

• Existing bleeding risk scores (CRUSADE, ACTION, ACUITY-HORIZONS) were developed in Caucasian populations.
• Their predictive performance in Chinese patients with ST-elevation myocardial infarction (STEMI) is not well-established.

Purpose of the Study:

• To compare the predictive ability of CRUSADE, ACTION, and ACUITY-HORIZONS bleeding scores in Chinese STEMI patients undergoing primary percutaneous coronary intervention (PPCI).
• To assess the prognostic value of these scores for 1-year mortality.

Main Methods:

• Retrospective analysis of 2,208 consecutive Chinese STEMI patients undergoing PPCI.
• Major bleeding events defined by Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5).
• Logistic regression and Area Under the Curve (AUC) used to assess predictive ability; Cox proportional hazard modeling for mortality.

Main Results:

• The overall major bleeding rate was 2.4%.
• AUC values were: CRUSADE 0.88, ACTION 0.90, and ACUITY-HORIZONS 0.78.
• The ACUITY-HORIZONS score showed unacceptable calibration. Both CRUSADE and ACTION scores demonstrated superior predictive ability for major bleeding compared to ACUITY-HORIZONS.
• High-risk stratification by CRUSADE and ACTION scores was associated with a 4-7 fold increase in 1-year mortality.

Conclusions:

• CRUSADE and ACTION bleeding scores demonstrate superior predictive accuracy for major bleeding in Chinese STEMI patients undergoing PPCI compared to the ACUITY-HORIZONS score.
• These scores effectively stratify risk, indicating increased 1-year mortality from low- to high-risk categories.