CRUSADE Score is Superior to Platelet Function Testing for Prediction of Bleeding in Patients Following Coronary Interventions

Abstract

Hypothetically, diminished platelet reactivity (PR) during dual antiplatelet therapy (DAPT) should cause extra major bleeding events (MBE), although definite evidence is lacking. Multiple scores have been proposed to stratify bleeding risk, but their predictive value during DAPT is unclear. We compared the performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) with PR testing to predict MBE in Korean patients with acute coronary syndrome. We screened 1105, and included 903 consecutive patients who underwent coronary interventions. All patients received DAPT, while MBE were assessed by BARC scale. Admission platelet reactivity was assessed with VerifyNow Analyzer simultaneously with CRUSADE score, and MBE were collected at 1 month and at 1 year post stenting. There were a total of 113 (11%) MBE at 1 month, and extra 41(5%) MBE at 1 year. At 1 month MBE prediction was superior by CRUSADE score (AUC: 0.816, 95% CI: 0.79 0.84, p < 0.0001), compared to PR (AUC: 0.605, 95% CI: 0.572–0.637, p = 0.0007). Moreover, CRUSADE score remains the independent predictor of MBE by multivariate analyses (OR = 2.94, 95% CI: 2.18–3.96, p < 0.0001). At 1 year MBE also correlated, but were not significantly different between admission CRUSADE score (AUC: 0.62, 95% CI: 0.58 0.66, p = 0.0183) and PR (AUC: 0.674, 95% CI: 0.63–0.71, p = 0.002). We conclude that MBE are more common in real life than reported in clinical trials. CRUSADE score was superior to PR testing for predicting short-term, but not 1 year MBE in Korean patients undergoing percutaneous coronary intervention and treated with DAPT.

Comparison of ACUITY, CRUSADE, and GRACE Risk Scales for Predicting Clinical Outcomes in Patients Treated with Dual-Antiplatelet Therapy

“…6 7 We recently show that CRUSADE score was superior to platelet testing for predicting short-term, but not 1-year, bleeding in post–percutaneous coronary intervention (PCI) Korean patients treated with DAPT. 8…”

Performance of HAS-BLED and CRUSADE risk scores for the prediction of haemorrhagic events in patients with stable coronary artery disease

“…In other studies, the CRUSADE score has been shown to be effective in predicting major bleeding in patients undergoing PCI, 13,14 and was shown to be even more valuable than the platelet reactivity test in PCI patients. 15 It can be used to predict mortality risk, similar to the GRACE risk score in ACS patients, 16 and to predict bleeding risk in STEMI patients. 17 The prognostic accuracy of the CRUSADE score can be used to predict major or moderate bleeding events even in non-invasively treated ACS patients.…”

Bleeding risk scales in patients with acute coronary syndrome: place of the ORACUL scale

“…Шкала CRUSADE лучше предсказывает риск больших кровотечений в течение 1 мес. после ЧКВ у больных после ОКС, чем тестирование остаточной активности тромбоцитов методом VerifyNow -с-критерий для шкалы CRUSADE -0,81, а для тестирования агрегации тромбоцитов -0,61 [26]. CRUSADE является одной из самых точных шкал риска кровотечений -ее чувствительность составляет 80%, специфичность -73% [27].…”