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

• Published in: Chinese medical journal 2018-02, Vol.131 (3), p.262-267
• Main Authors: Zhao, Xue-Yan, Li, Jian-Xin, Tang, Xiao-Fang, Xian, Ying, Xu, Jing-Jing, Song, Ying, Jiang, Lin, Xu, Lian-Jun, Chen, Jue, Zhang, Yin, Song, Lei, Gao, Li-Jian, Gao, Zhan, Zhang, Jun, Wu, Yuan, Qiao, Shu-Bin, Yang, Yue-Jin, Gao, Run-Lin, Xu, Bo, Yuan, Jin-Qing
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 0366-6999; 2542-5641
• DOI: 10.4103/0366-6999.223858

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.