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

Xue-yan Zhao; Jian-xin LI; Xiao-fang Tang; Ying Xian; Jing-jing XU; Ying Song; Lin Jiang; Lian-jun XU; Jue Chen; Yin Zhang; Lei Song; Li-jian Gao; Zhan Gao; Jun Zhang; Yuan WU; Shu-bin Qiao; Yue-jin Yang; Run-lin Gao; Bo XU; Jin-qing Yuan

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

Author: Xue-Yan ZHAO ¹ ; Jian-Xin LI ¹ ; Xiao-Fang TANG ¹ ; Ying XIAN ² ; Jing-Jing XU ¹ ; Ying SONG ¹ ; Lin JIANG ¹ ; Lian-Jun XU ¹ ; Jue CHEN ¹ ; Yin ZHANG ¹ ; Lei SONG ¹ ; Li-Jian GAO ¹ ; Zhan GAO ¹ ; Jun ZHANG ¹ ; Yuan WU ¹ ; Shu-Bin QIAO ¹ ; Yue-Jin YANG ¹ ; Run-Lin GAO ¹ ; Bo XU ¹ ; Jin-Qing YUAN ¹
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1. 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.
2. Department of Neurology, Duke Clinical Research Institute, Durham, NC 27705, USA.
Publication Type:Journal Article
MeSH: Acute Coronary Syndrome; therapy; Aged; Angina, Unstable; therapy; Drug-Eluting Stents; Female; Humans; Male; Middle Aged; Myocardial Infarction; therapy; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; adverse effects; Postoperative Hemorrhage; chemically induced; diagnosis; epidemiology; surgery; Practice Guidelines as Topic; Prognosis; Prospective Studies; Research Design; Risk; Risk Assessment; Treatment Outcome
From: Chinese Medical Journal 2018;131(3):262-267
CountryChina
Language:English
Abstract: 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.