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CRUSADE: Is it still a good score to predict bleeding in acute coronary syndrome?
- Source :
-
Revista portuguesa de cardiologia [Rev Port Cardiol (Engl Ed)] 2018 Nov; Vol. 37 (11), pp. 889-897. Date of Electronic Publication: 2018 Nov 22. - Publication Year :
- 2018
-
Abstract
- 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.<br />Objective: To assess the predictive ability of the CRUSADE score in a contemporary ACS population.<br />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.<br />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.<br />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.<br /> (Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Subjects :
- Aged
Female
Hospitalization
Humans
Incidence
Male
Middle Aged
Predictive Value of Tests
Prognosis
Retrospective Studies
Risk Factors
Acute Coronary Syndrome complications
Acute Coronary Syndrome diagnosis
Acute Coronary Syndrome epidemiology
Hemorrhage diagnosis
Hemorrhage epidemiology
Hemorrhage etiology
Subjects
Details
- Language :
- English; Portuguese
- ISSN :
- 2174-2049
- Volume :
- 37
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Revista portuguesa de cardiologia
- Publication Type :
- Academic Journal
- Accession number :
- 30471747
- Full Text :
- https://doi.org/10.1016/j.repc.2018.02.008