Key result
CRUSADE score outperforms ACTION and Mehran scores for predicting bleeding risk in ACS patients.
Why the study?
Hemorrhagic complications are strongly linked with adverse outcomes in ACS patients, and various risk scores exist to estimate bleeding risk, prompting a comparison of the predictive accuracy of three contemporary bleeding risk scores.
Does the CRUSADE bleeding risk score improve the prediction of major and TIMI serious bleeding events compared to the ACTION and Mehran et al scores in patients with acute coronary syndrome?
Cohort (n=4,500)
Does the CRUSADE bleeding risk score improve the prediction of major and TIMI serious bleeding events compared to the ACTION and Mehran et al scores in patients with acute coronary syndrome?
Among contemporary bleeding risk scores, the CRUSADE score is the most accurate and well-calibrated tool for stratifying bleeding risk in both NSTEACS and STEMI patients, though all scores perform modestly in conservatively managed patients.
Answers are grounded in this paper and cite their sources.
Supports preferring CRUSADE for ACS bleeding stratification; leaves open prospective outcome trials before practice change.
Background: Hemorrhagic complications are strongly linked with subsequent adverse outcomes in acute coronary syndrome (ACS) patients. Various risk scores (RS) are available to estimate the bleeding risk in these patients. : To compare the predictive accuracy of the three contemporary bleeding in ACS. : We studied 4500 consecutive patients with ACS. For each patient, ACTION, CRUSADE, and Mehran et al bleeding RS were calculated. We their performance either for the prediction of their own major bleeding events or to predict the TIMI serious (major and minor) bleeding episodes the overall population, in patients with non-ST elevation ACS (NSTEACS) in those with ST-elevation myocardial infarction (STEMI) patients. Calibration (Hosmer-Lemeshow test) and discrimination (c-statistic) for the three RS were and compared. We used the concept of net reclassification improvement (NRI) to compare the incremental prognostic value of using a particular RS the remaining scores in predicting the TIMI serious bleeding. : The best predictive accuracy was obtained by the CRUSADE score either for the prediction of its own major bleeding events (c-statistic=0.80, 0.791, 0.81 for the entire sample, for STEMI, and for NSTEACS patients, respectively) or to predict the TIMI serious bleed occurrence (c-statistic=0.741, 0.738,and 0.745 for the whole population, for STEMI and NSTEACS patients, respectively). The lowest bleeding rates observed in patients classified as low risk corresponded to the CRUSADE RS. All scores performed modestly in patients who not undergo coronariography (all c-statistic <0.70). The CRUSADE score was superior to the ACTION model in predicting the TIMI serious bleeding in terms of NRI overall and by ACS subgroups (p<0.05). Overall, the RS exhibited better calibration for predicting the TIMI serious bleeding to the ACTION and Mehran et al scores (Hosmer-Lemeshow p-values 0.26, 0.13, and 0.07, respectively). : The CRUSADE score represents, among the more contemporary RS, the most accurate and reliable quantitative clinical tool in STEACS STEMI patients. We encourage the utilization of the CRUSADE index for risk stratification purposes in daily clinical practice and in ACS outcome . The performance of the three more contemporary bleeding RS is modest those patients who received conservative management.
No takes yet. Share an insight, caveat, or question.
Kobayashi et al. (2012) conducted a cohort in Acute coronary syndrome (ACS), including non-ST-elevation ACS (NSTEACS) and ST-elevation myocardial infarction (STEMI) (n=4,500). CRUSADE bleeding risk score vs. ACTION and Mehran et al bleeding risk scores was evaluated on Prediction of major bleeding events and TIMI serious (major and minor) bleeding episodes (p=<0.05). The CRUSADE score outperformed ACTION and Mehran scores in predicting major bleeding (c-statistic 0.80) and TIMI serious bleeding (c-statistic 0.741; NRI p<0.05 vs ACTION) in ACS patients.
Synapse has enriched 10 related papers. Consider them for comparative context: