Journal Article

Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions

Gao, Li-Jian, Zhang, Yin, Xu, Lian-Jun, Zhao, Xue-Yan, Tang, Xiao-Fang, Gao, Zhan, Jiang, Lin, Xian, Ying, Li, Jian-Xin, Chen, Jue, Gao, Run-Lin, Xu, Bo, Song, Ying, Xu, Jing-Jing, Yuan, Jin-Qing, Song, Lei, Wu, Yuan, Yang, Yue-Jin, Qiao, Shu-Bin, Zhang, Jun

2018

Overview

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.

• Publisher: Wolters Kluwer India Pvt. Ltd,Medknow Publications and Media Pvt. Ltd,Lippincott Williams & Wilkins Ovid Technologies,Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China%Department of Neurology, Duke Clinical Research Institute, Durham, NC 27705, USA,Medknow Publications & Media Pvt Ltd,Wolters Kluwer
• Subject: Acute Coronary Syndrome - therapy / Aged / Analysis / Angina, Unstable - therapy / Angioplasty / Balloon angioplasty / Bleeding Score; Dual Antiplatelet Therapy; Major Bleeding; Percutaneous Coronary Intervention; Prognosis / Blood / Care and treatment / Complications and side effects / Drug-Eluting Stents / Family medical history / Female / Health risk assessment / Heart attack / Heart attacks / Hemorrhage / Hospitals / Humans / Male / Medical imaging / Middle Aged / Myocardial Infarction - therapy / Normal distribution / Original / Patient outcomes / Percutaneous Coronary Intervention / Platelet Aggregation Inhibitors - adverse effects / Postoperative Hemorrhage - chemically induced / Postoperative Hemorrhage - diagnosis / Postoperative Hemorrhage - epidemiology / Postoperative Hemorrhage - surgery / Practice Guidelines as Topic / Prognosis / Prospective Studies / R&D / Research & development / Research Design / Risk / Risk Assessment / Risk factors / Statistical analysis / Stents / Thrombosis / Treatment Outcome