CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.
INTRODUCTION
The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI).


MATERIALS AND METHODS
We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC).


RESULTS
We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001).


CONCLUSIONS
Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.
['Ariza-Solé|Albert|A|', 'Sánchez-Elvira|Guillermo|G|', 'Sánchez-Salado|José C|JC|', 'Lorente-Tordera|Victoria|V|', 'Salazar-Mendiguchía|Joel|J|', 'Sánchez-Prieto|Remedios|R|', 'Romaguera-Torres|Rafael|R|', 'Ferreiro-Gutiérrez|José L|JL|', 'Gómez-Hospital|Joan A|JA|', 'Cequier-Fillat|Angel|A|']
D000925:Anticoagulants D001777:Blood Coagulation D005260:Female D006470:Hemorrhage D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011379:Prognosis D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D016896:Treatment Outcome D054556:Venous Thromboembolism D020246:Venous Thrombosis
Bleeding Percutaneous coronary intervention CBRS Non-ST segment elevation myocardial infarction NSTEMI ST segment elevation myocardial infarction STEMI ACS Acute coronary syndromes CRUSADE) bleeding risk score PCI Prognosis