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Updated CRUSADE score to predict in-hospital bleeding: External validation in the Thai percutaneous coronary
Ply Chichareon1, Noppadol Chamnarnphol1, Mann Chandavimol2
1Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Insights
The CRUSADE score effectively predicts bleeding risk in Asian patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI). Both full and simplified versions demonstrated strong performance in the Thai population.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Interventional Cardiology
Background:
- The CRUSADE score is recommended for predicting in-hospital bleeding risk in non-ST segment elevation myocardial infarction (NSTEMI) patients.
- Validation of the CRUSADE score in Asian populations undergoing percutaneous coronary intervention (PCI) is needed.
Purpose of the Study:
- To validate and update the CRUSADE score for predicting in-hospital major bleeding in NSTEMI patients treated with PCI.
- To assess the performance of a simplified CRUSADE score in this patient cohort.
Main Methods:
- Utilized data from the Thai PCI registry (May 2018 - August 2019).
- Calculated the CRUSADE score based on 8 predictors and fitted to in-hospital major bleeding using logistic regression.
- Revised and simplified the score, evaluating performance using C-statistics and calibration.
Main Results:
- The original CRUSADE score showed good predictive ability (C-statistic 0.817).
- The revised and simplified CRUSADE score (4 variables) demonstrated excellent performance (C-statistics 0.839 and 0.837, respectively).
- The simplified score achieved optimal calibration in the Thai NSTEMI population.
Conclusions:
- The CRUSADE risk score, in both full and simplified forms, is well-suited for predicting bleeding risk in Thai NSTEMI patients undergoing PCI.
- The simplified CRUSADE score offers a practical tool for risk stratification in this demographic.
Background:
The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) score has been recommended to predict in-hospital bleeding risk in non-ST segment elevation myocardial infarction (NSTEMI) patients. The evaluation of the CRUSADE risk score in Asian patients undergoing contemporary percutaneous coronary intervention (PCI) for NSTEMI is necessary.
Aims:
We aimed to validate and update the CRUSADE score to predict in-hospital major bleeding in NSTEMI patients treated with PCI.
Method:
The Thai PCI registry is a large, prospective, multicenter PCI registry in Thailand enrolling patients between May 2018 and August 2019. The CRUSADE score was calculated based on 8 predictors including sex, diabetes, prior vascular disease (PVD), congestive heart failure (CHF), creatinine clearance (CrCl), hematocrit, systolic blood pressure, and heart rate (HR). The score was fitted to in-hospital major bleeding using the logistic regression. The original score was revised and updated for simplification.
Results:
Of 19,701 patients in the Thai PCI registry, 5976 patients presented with NSTEMI. The CRUSADE score was calculated in 5882 patients who had all variables of the score available. Thirty-five percent were female, with a median age of 65.1 years. The proportion of diabetes, PVD, and CHF was 46%, 7.9%, and 11.2%, respectively. The original and revised models of the CRUSADE risk score had C-statistics of 0.817 (95% CI: 0.762-0.871) and 0.839 (95% CI: 0.789-0.889) respectively. The simplified CRUSADE score which contained only four variables (hematocrit, CrCl, HR, and CHF), had C-statistics of 0.837 (0.787-0.886). The calibration of the recalibrated, revised, and simplified model was optimal.
Conclusions:
The full and simplified CRUSADE scores performed well in NSTEMI treated with PCI in Thai population.
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