Abstract 13103: Is Crusade Score Useful for Predicting Major Bleeding Risk in Patients Undergoing Primary Angioplasty?
BACKGROUND AND OBJECTIVES The CRUSADE(Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines) scale is a useful risk model for predicting the probability of bleeding after a non ST elevation acute coronary syndrome (ACS). We pretend to evaluate its capability to predict bleeding in patients presenting with ST elevation ACS treated with primary angioplasty(PAp).
METHODS. We analyzed a cohort of 1503 consecutive patients who underwent primary angioplasty in our institution between years 2006 & 2010 (79 % male, mean age 66 years, 81 % radial access). We quantified the occurrence of major bleeding as defined by the CRUSADE criteria. CRUSADE risk score was calculated. Discrimination capability of the model was evaluated with the C statistic (area under curve) by means of logistic regression and ROC curves
RESULTS Incidence of CRUSADE major bleeding was high (31.6%). The majority of cases (89.6%) were due to haematocrit decrease > 12 points without clinical correlation. Blood transfusion need with identified bleeding cause (5.9 %), transfusion without known bleeding cause (3.8 %), retroperitoneal hematoma and intracranial bleeding (0.2 %) were not frequently observed. Bleeding incidence was higher among the CRUSADE highest risk groups (very low risk 21.6 %; low risk 34.7 %; moderate risk 38 %; high risk 51.9 %, very high risk 54.3 %). CRUSADE score showed a moderate capacity of discrimination in the total group and also in the analyzed subgroups (elderly, women, abciximab treated, radial and femoral accesses) [C statistics 0.66-0.72] (see table)
CONCLUSIONS The incidence of CRUSADE major bleeding in PAp although high, is mainly due to asymptomatic haematrocrit decrease. CRUSADE model seems to be useful for bleeding risk stratification in PAp not only in the overall group but in the different analyzed subgroups as well.
- © 2011 by American Heart Association, Inc.