Major bleeding events in Jordanian patients undergoing percutaneous coronary intervention (PCI): Incidence, associated factors, impact on prognosis, and predictability of the CRUSADE bleeding risk score. Results from the First Jordanian PCR (PCR1)

Abstract

Objective:Determine the incidence of major bleeding events, their risk factors, and their impact on prognosis in Jordanian patients undergoing percutaneous coronary intervention (PCI). Evaluate the ability of the CRUSADE bleeding risk score (BRS) to predict major bleeding.Methods:Major bleeding events were defined according to the CRUSADE classification and their incidence was evaluated from hospital admission to one year of follow up. The CRUSADE bleeding risk score was calculated for each patient during the index admission. Incidence of major bleeding events was evaluated in each of the bleeding score quintiles. JoPCR1 is a prospective, observational, multicenter registry of consecutive patients who underwent PCI at 12 tertiary care centers in Jordan. A case report form was used to record data prospectively at hospital admission, at discharge, and at 1 and 12 months of follow-up.Results:The study included 2426 consecutive patients who underwent PCI. During the index hospitalization, major and minor bleeding events occurred in 0.95% and 2.6% of patients, respectively. Multivariate analysis showed that only two variables were significantly associated with major bleeding: female gender (OR=3.7; 95% CI 1.6, 8.5; p=0.002) and past history of cardiovascular disease (OR=2.6; 95% CI 1.1, 5.9; p=0.026). Patients who had in-hospital major bleeding events had higher cardiac mortality during index hospitalization (13.0% vs. 0.7%, p<0.005) and at one year of follow up (13.0% vs. 1.8%, p<0.005) compared to those who had no such events. Receiver operating characteristic curve analysis showed that the CRUSADE BRS has a high ability to predict major bleeding.Conclusion:Major bleeding events were uncommon in this ME registry of a contemporary cohort of patients undergoing PCI but were associated with a higher mortality rate compared with those who did not have major bleeding events. CRUSADE BRS was highly predictive of the incidence of major bleeding events.

Sex‐based differences in bleeding and long‐term adverse events after percutaneous coronary intervention in older patients with coronary artery disease

“…This finding is similar to the HORIZONS-AMI trial substudy, in which women had a less favorable cardiovascular risk profile compared with men, and had significantly higher rates of 3-year MACE and major bleeding. 23 In that study, after adjusting for differences in baseline and treatment characteristics, female sex remained an independent predictor of poor outcomes in terms of long-term major bleeding, but not of overall MACE or death.…”

“…Differences in the definition of major bleeding used in these studies may also contribute to the varying results. 16,23 We used the BARC bleeding definition criteria, which provides a balanced combination of laboratory and clinical metrics for bleeding recognition. 16 We also included the BARC bleeding types 1, 2, 3, and 5 in our analyses, and found that out of a total of 355 bleeding cases, >50% were type 1 (194).…”

“…Differences in the definition of major bleeding used in these studies may also contribute to the varying results . We used the BARC bleeding definition criteria, which provides a balanced combination of laboratory and clinical metrics for bleeding recognition .…”

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

“…The CRUSADE score has been studied several times to predict bleeding risk in patients with coronary artery disease, especially in NSTEMI patients. 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.…”