Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome

Abu‐Assi, Emad; Raposeiras‐Roubín, Sergio; Lear, Pamela; Cabanas‐Grandío, Pilar; Girondo, Mar Rodriguez; Rodríguez-Cordero, Marta; Pereira-López, Eva; Romaní, Santiago Gestal; González-Cambeiro, Cristina; Álvarez‐Álvarez, Belén; Garcı́a-Acuña, José Marı́a; González-Juanatey, José Ramón

doi:10.1177/2048872612453924

Cited by 66 publications

(33 citation statements)

References 27 publications

(52 reference statements)

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“…Among the risk scores explored, we found CRUSADE to have a better predictive profile for major bleeding compared with HAS‐BLED and a similar profile compared to ACUITY. This observation is consistent with some previous studies and with the European Society of Cardiology guidelines that recommended the CRUSADE score for bleeding risk stratification in non–ST‐segment elevation MI 9, 15, 16. It might be speculated that the set of covariates used to predict bleeding risk for the CRUSADE score better reflects the bleeding risk in patients undergoing stent implantation and subsequent DAPT.…”

Section: Discussionsupporting

confidence: 91%

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Costa

Tijssen

Ariotti

et al. 2015

JAHA

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BackgroundMultiple scores have been proposed to stratify bleeding risk, but their value to guide dual antiplatelet therapy duration has never been appraised. We compared the performance of the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines), ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy), and HAS‐BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol Concomitantly) scores in 1946 patients recruited in the Prolonging Dual Antiplatelet Treatment After Grading Stent‐Induced Intimal Hyperplasia Study (PRODIGY) and assessed hemorrhagic and ischemic events in the 24‐ and 6‐month dual antiplatelet therapy groups.Methods and ResultsBleeding score performance was assessed with a Cox regression model and C statistics. Discriminative and reclassification power was assessed with net reclassification improvement and integrated discrimination improvement. The C statistic was similar between the CRUSADE score (area under the curve 0.71) and ACUITY (area under the curve 0.68), and higher than HAS−BLED (area under the curve 0.63). CRUSADE, but not ACUITY, improved reclassification (net reclassification index 0.39, P=0.005) and discrimination (integrated discrimination improvement index 0.0083, P=0.021) of major bleeding compared with HAS‐BLED. Major bleeding and transfusions were higher in the 24‐ versus 6‐month dual antiplatelet therapy groups in patients with a CRUSADE score >40 (hazard ratio for bleeding 2.69, P=0.035; hazard ratio for transfusions 4.65, P=0.009) but not in those with CRUSADE score ≤40 (hazard ratio for bleeding 1.50, P=0.25; hazard ratio for transfusions 1.37, P=0.44), with positive interaction (P int=0.05 and P int=0.01, respectively). The number of patients with high CRUSADE scores needed to treat for harm for major bleeding and transfusion were 17 and 15, respectively, with 24‐month rather than 6‐month dual antiplatelet therapy; corresponding figures in the overall population were 67 and 71, respectively.ConclusionsOur analysis suggests that the CRUSADE score predicts major bleeding similarly to ACUITY and better than HAS BLED in an all‐comer population with percutaneous coronary intervention and potentially identifies patients at higher risk of hemorrhagic complications when treated with a long‐term dual antiplatelet therapy regimen.Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00611286.

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Section: Discussionsupporting

confidence: 91%

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Costa

Tijssen

Ariotti

et al. 2015

JAHA

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“…18 Amador et al first suggested that both ischaemic and bleeding risk scores could be used to predict in-hospital mortality, isch- In conclusion, the results of this study support previous findings on the superiority of the GRACE vs the CRUSADE score to predict in-hospital mortality in ACS patients, and adds to the growing evidence that this score might also serve the needs to predict bleeding complications. 18 Amador et al first suggested that both ischaemic and bleeding risk scores could be used to predict in-hospital mortality, isch- In conclusion, the results of this study support previous findings on the superiority of the GRACE vs the CRUSADE score to predict in-hospital mortality in ACS patients, and adds to the growing evidence that this score might also serve the needs to predict bleeding complications.…”

Section: Plications In Stemi and Nste-acs Compared With Action-andsupporting

confidence: 87%

“…AUC, area under the curve GRACE Score and enrolled 13 686 Canadian ACS patients from 1999-2008. Current guidelines recommend the use of the CRUSADE score for bleeding risk stratification 8,18,19. They concluded that the number of risk factorsdoes not enhance the prognostic value over the validated GRACE risk score 15.…”

mentioning

confidence: 99%

Risk stratification in acute coronary syndrome: Evaluation of the GRACE and CRUSADE scores in the setting of a tertiary care centre

et al. 2019

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Objective Risk assessment plays a decisive role in the management of acute coronary syndrome (ACS). The GRACE and the CRUSADE scores are among the most frequently used risk assessment tools. We aimed to compare the performance of the GRACE and CRUSADE risk scores to predict in‐hospital mortality and major bleeding in a contemporary ACS population at a high‐volume academic hospital. Methods All patients treated for ACS from January 1, 2006 to December 31, 2015 at a tertiary care centre were prospectively enrolled. We calculated GRACE and CRUSADE risk scores. We compared the discrimination capacity of both scores for in‐hospital mortality and major bleeding. Results In total 4087 patients (1151 [28.2%] female; age 62 ± 14 years) were included. Among these 2218 (54.3%) were diagnosed with ST‐elevation myocardial infarction, 113 (2.8%) died in hospital and major bleeding occurred in 65 (1.6%). Discrimination capacity for in‐hospital mortality of the GRACE score was superior to the CRUSADE score (receiver operator characteristic area under the curve (AUC) 0.91 (95% CI 0.89‐0.93) vs 0.83 (95% CI 0.80‐0.86); P < .01). Performance for major bleeding differed but was poor for both scores (AUC 0.71 [0.65‐0.76] for GRACE vs 0.61 [0.55‐0.68] for CRUSADE; P < .01). Conclusion The GRACE score appears to be superior over CRUSADE to predict in‐hospital mortality. Major bleeding is rare in the era of primary PCI and performance of both scores for this outcome was poor.

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“…1 The Mehran bleeding score is straightforward to calculate, encompasses several clinical and biochemical parameters, and has been validated in several studies. 7,8 In the present study, the average Mehran bleed score was significantly higher in patients treated with warfarin. The predicted risk of 30 days of the patient in the very high bleed score category (38% of the patients treated with warfarin score >20) is 10%.…”

Section: Discussionmentioning

confidence: 85%

“…6 As with other studies, we modified this slightly by excluding periprocedural anticoagulant therapy. 7 It is important to note that the Mehran bleed score does not include baseline use of warfarin. For SYNTAX score calculation, an on-line calculator was used (http://ir-nwr.ru/ calculators/syntaxscore.htm).…”

Section: Methodsmentioning

confidence: 99%

Complex Disease, Partial Revascularization, and Adverse Outcomes in Patients Treated With Long-Term Warfarin Therapy Who Underwent Percutaneous Coronary Intervention

Yazji¹,

Kakhi²,

Ossei-Gerning³

et al. 2015

The American Journal of Cardiology

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Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome

Abstract: Of contemporary bleeding RS, the CRUSADE score was found to be the most accurate quantitative tool for NSTEACS and STEMI patients undergoing coronary arteriography.

Cited by 66 publications

References 27 publications

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

Risk stratification in acute coronary syndrome: Evaluation of the GRACE and CRUSADE scores in the setting of a tertiary care centre

Complex Disease, Partial Revascularization, and Adverse Outcomes in Patients Treated With Long-Term Warfarin Therapy Who Underwent Percutaneous Coronary Intervention

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