The Performance of CRUSADE and ACUITY Bleeding Risk Scores in Ticagrelor-Treated ACS Patients Who Underwent PCI

Abstract

The performance of the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) and ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) risk scores for the prediction of major bleeding in ticagrelor-treated acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI) is unknown. The aim of the present study is to validate the performance of both scores in a contemporary Chinese cohort of ACS patients hospitalized for PCI and administrated with ticagrelor. From January 2013 to December 2014, a total of 629 ticagrelor-treated ACS patients who underwent PCI were recruited consecutively. The overall rate of major bleeding defined by the BARC (Bleeding Academic Research Consortium) criteria was 1.7%. This incidence increased with the risk category of both the CRUSADE (very low, 0.6%; low, 1.3%; moderate, 1.1%; high, 7.0%; and very high, 13.0%; = 0.001) and the ACUITY score (low, 0.6%; moderate, 1.4%; high, 4.9%; and very high, 7.0%; = 0.003). The CRUSADE score demonstrated adequate calibration and discriminatory capacity for the patients as a whole (HL- [Hosmer-Lemeshow goodness-of-fit test -value]>0.3; AUC [area under the curve]: 0.78), with the excellent performance in the subgroups of acute myocardial infarction, men, diabetes and those implanted with more than two DESs (AUC: 0.85, 0.80, 0.93 and 0.93, respectively). For the ACUITY score, adequate calibration and discriminatory capacity could be observed for the whole patients (HL- > 0.3; AUC: 0.78), with excellent performance for the patients with diabetes or those implanted with more than two DESs (AUC: 0.90 and 0.97, respectively). In conclusion, both CRUSADE and ACUITY risk scores performed adequate discriminatory power for the prediction of major bleeding within 30 days in ticagrelor-treated ACS patients who underwent PCI.

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

“…Our data are in full agreement with another recent study suggesting that both CRUSADE and ACUITY risk scores performed adequate discriminatory power for the prediction of MB within 30 days in ticagrelor-treated ACS patients. 18 In fact, these three scores differ very significantly in our patient mixed cohort. ACUITY and GRACE include the wide scale of ACS, whereas CRUSADE applied almost exclusively to unstable angina.…”

Comparative Assessment of Predictive Performance of PRECISE-DAPT, CRUSADE, and ACUITY Scores in Risk Stratifying 30-Day Bleeding Events

“…Despite their historical derivation, recent data show that both the CRUSADE and ACUITY scores have equivalent capacity for the prediction of bleeding at 30 days after PCI, even in patients with ACS receiving ticagrelor. 9 However, the CRUSADE and ACUITY scores are rarely used in the routine practice and are suitable for patients without taking oral anticoagulation. 5 6 The changes in interventional practice such as the use of radial access for coronary angiography and PCI, and the shorter duration of DAPT might modify the predictive performance of bleeding risk scores.…”

“…The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines) and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) bleeding risk scores 5 6 have been developed to estimate the baseline risk for short-term major bleeding. 7 8 9 10 Historically, the CRUSADE score was designed for non-ST elevation myocardial infarction (STEMI) population, whereas the ACUITY score was derived from ACS population. Recently, the PRECISE-DAPT (Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score has been developed from the PLATO trial (ACS population) and Bern PCI registry (all-comers population).…”

Bleeding rate and diagnostic value of different hemorrhagic risk scores in certain clinical groups of patients with acute coronary syndrome

“…Диагностическая ценность шкалы CRUSADE у больных, подвергшихся ЧКВ, оказалась даже несколько выше ценности шкалы ACUITY. Это преимущество сохранилось и при анализе больных с группах, отличающихся по полу, наличию сахарного диабета и хронической болезни почек [24]. В нашем исследовании достоверных различий в прогностической ценности упомя-нутых шкал у больных с разной тактикой ведения не выявлено, так же как и преимущества какой-либо из шкал у больных с инвазивной тактикой ведения.…”

“…Крайне скудными являются сведения, касающиеся информативности различных шкал оценки риска кровотечений у больных диабетом. В небольшом исследовании на группе из 629 больных ОКС, получивших лечение тикагрелором после ОКС, было показано, что и шкала CRUSADE, и шкала ACUITY демонстрировали высокую прогностическую значимость как в целом для всей группы (площадь под ROCкривой 0,78 для обеих шкал), так и у больных с сахарным диабетом (0,8 для шкалы CRUSADE и 0,9 для шкалы ACUITY) [24]. В нашем исследовании шкалы CRUSADE и ACUITY имели более низкую диагностическую значимость у больных с сахарным диабетом, а максимальную площадь под ROC-кривой продемонстрировала разработанная нами шкала ОРАКУЛ.…”