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Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non–ST-Segment Elevation Acute Myocardial Infarction

2010; Lippincott Williams & Wilkins; Volume: 121; Issue: 22 Linguagem: Inglês

10.1161/circulationaha.109.925594

1524-4539

Emad Abu-Assi, José María Gracía-Acuña, Ignacio Ferreira‐González, Carlos Peña, Pilar Díz, José Ramón González–Juanatey,

Antiplatelet Therapy and Cardiovascular Diseases

The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) model provides a risk score that predicts the likelihood of major bleeding in patients hospitalized for non-ST-elevation acute myocardial infarction. The aim of the present work was to evaluate the performance of this model in a contemporary cohort of patients hospitalized for non-ST-elevation acute myocardial infarction in Spain.The study subjects were 782 consecutive patients admitted to our center between February 2004 and June 2009 with non-ST-elevation acute myocardial infarction. For each patient, we calculated the CRUSADE risk score and evaluated its discrimination and calibration by the C statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The performance of the CRUSADE risk score was evaluated for the patient population as a whole and for groups of patients treated with or without >or=2 antithrombotic medications and who underwent cardiac catheterization or not. The median CRUSADE score was 30 points (range, 18 to 45). A total of 657 patients (84%) were treated with >or=2 antithrombotic, of whom 609 (92.7%) underwent cardiac catheterization. The overall incidence of major bleeding was 9.5%. This incidence increased with the risk category: very low, 1.5%; low, 4.3%; moderate, 7.8%; high, 11.8%; and very high, 28.9% (P or=2 antithrombotics, and for the subgroup treated with >or=2 antithrombotics who did or did not undergo cardiac catheterization, the CRUSADE score showed adequate calibration and excellent discriminatory capacity (Hosmer-Lemeshow P>0.3 and C values of 0.82, 0.80, 0.70, and 0.80, respectively). However, it showed little capacity to discriminate bleeding risk in patients treated with >or=2 antithrombotics who did not undergo cardiac catheterization (C=0.56).The CRUSADE risk score was generally validated and found to be useful in a Spanish cohort of patients treated with or without >or=2 antithrombotics and in those treated with or without >or=2 antithrombotics who underwent cardiac catheterization. More studies are needed to clarify the validity of the CRUSADE score in the subgroup treated with >or=2 antithrombotics who do not undergo cardiac catheterization.