CRUSADE: Is it still a good score to predict bleeding in acute coronary syndrome?
Dina Bento1, Nuno Marques2, Pedro Azevedo1
1Serviço de Cardiologia, Centro Hospitalar Universitário do Algarve, Faro, Portugal.
Insights
The CRUSADE bleeding score overestimates major bleeding risk in acute coronary syndrome (ACS) patients. This study suggests re-evaluating its use for risk stratification in contemporary ACS populations.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Medical Informatics
Background:
- Major bleeding is a significant complication in acute coronary syndrome (ACS), impacting patient prognosis.
- The CRUSADE bleeding score is a tool used to assess bleeding risk in ACS patients.
Purpose of the Study:
- To evaluate the predictive accuracy of the CRUSADE score in a modern ACS patient cohort.
- To identify independent predictors of in-hospital major bleeding (IHMB) in ACS.
Main Methods:
- A retrospective analysis of 2818 ACS patients.
- Calculation of CRUSADE scores and assessment of discrimination (AUC) and goodness-of-fit (Hosmer-Lemeshow test).
- Identification of independent predictors for IHMB.
Main Results:
- The observed IHMB rate was 1.8%, significantly lower than the 7.1% predicted by the CRUSADE score.
- The CRUSADE score showed only moderate predictive ability (AUC 0.73) and overestimated bleeding risk, particularly in high-risk groups.
- Advanced age, femoral vascular access, higher heart rate, and ticagrelor use were independent predictors of IHMB.
Conclusions:
- The CRUSADE score significantly overestimates major bleeding risk in ACS patients, especially those at higher risk.
- The study questions the continued utility of the CRUSADE score for risk stratification in contemporary ACS populations.
- Independent predictors of IHMB were identified, offering potential for refined risk assessment.
Introduction:
Major bleeding is a serious complication of acute coronary syndrome (ACS) and is associated with a worse prognosis. The CRUSADE bleeding score is used to stratify the risk of major bleeding in ACS.
Objective:
To assess the predictive ability of the CRUSADE score in a contemporary ACS population.
Methods:
In a single-center retrospective study of 2818 patients admitted with ACS, the CRUSADE score was calculated for each patient and its discrimination and goodness of fit were assessed by the area under the receiver operating characteristic curve (AUC) and by the Hosmer-Lemeshow test, respectively. Predictors of in-hospital major bleeding (IHMB) were determined.
Results:
The IHMB rate was 1.8%, significantly lower than predicted by the CRUSADE score (7.1%, p<0.001). The incidence of IHMB was 0.5% in the very low risk category (rate predicted by the score 3.1%), 1.5% in the low risk category (5.5%), 1.6% in the moderate risk category (8.6%), 5.5% in the high risk category (11.9%), and 4.4% in the very high risk category (19.5%). The predictive ability of the CRUSADE score for IHMB was only moderate (AUC 0.73). The in-hospital mortality rate was 4.0%. Advanced age (p=0.027), femoral vascular access (p=0.004), higher heart rate (p=0.047) and ticagrelor use (p=0.027) were independent predictors of IHMB.
Conclusions:
The CRUSADE score, although presenting some discriminatory power, significantly overestimated the IHMB rate, especially in patients at higher risk. These results question whether the CRUSADE score should continue to be used in the stratification of ACS.
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