Key result
CRUSADE and ACUITY-HORIZONS scores offer limited long-term prognostic value for out-of-hospital major bleeding after PCI.
Why the study?
Do CRUSADE and ACUITY-HORIZONS scores predict long-term out-of-hospital bleeding after PCI with DES?
Observational (n=10,724)
No
Do CRUSADE and ACUITY-HORIZONS scores predict long-term out-of-hospital bleeding after PCI with DES?
Effect estimate: AUROC 0.565 (95% CI 0.529-0.601)
p-value: p=0.001
CRUSADE and ACUITY-HORIZONS scores have statistically significant but limited long-term prognostic value for out-of-hospital major bleeding after PCI with DES.
Scores should not guide long-term bleeding risk assessment after PCI; leaves open need for dedicated long-term prediction models.
BACKGROUND: There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy. We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients. METHODS: We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital, China. All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center. Major bleeding was defined as Types 2, 3, and 5 according to Bleeding Academic Research Consortium Definition criteria. RESULTS: During a 2-year follow-up, 245 of 9782 patients (2.5%) had major bleeding (MB). CRUSADE (21.00 [12.00, 29.75] vs. 18.00 [11.00, 26.00], P < 0.001) and ACUITY-HORIZONS (9.00 [3.00, 14.00] vs. 6.00 [3.00, 12.00], P < 0.001) risk scores were both significantly higher in the MB than non-MB groups. Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC], 0.565; 95% confidence interval [CI], 0.529-0.601, P = 0.001; AUROC, 0.566; 95% CI, 0.529-0.603, P < 0.001, respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC: 0.579, 95% CI: 0.531-0.627, P = 0.001; AUROC, 0.591; 95% CI, 0.544-0.638, P < 0.001, respectively). However, neither score was a significant predictor in the non-ACS subgroup (P > 0.05). The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup. CONCLUSIONS: CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients. The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup.
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Li et al. (2018) conducted an observational in Patients undergoing percutaneous coronary interventions with drug-eluting stents receiving dual antiplatelet therapy (n=10,724). CRUSADE and ACUITY-HORIZONS scores was evaluated on Major bleeding (Bleeding Academic Research Consortium Types 2, 3, and 5) (AUROC 0.565, 95% CI 0.529-0.601, p=0.001). CRUSADE and ACUITY-HORIZONS scores showed limited long-term prognostic value for out-of-hospital major bleeding after PCI (AUROC 0.565 and 0.566, respectively).
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