Comparison of the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores in STEMI undergoing primary PCI: insights from a cohort of 1391 patients

Abstract

Aims: To compare the performance of the CRUSADE, ACUITY-HORIZONS, and ACTION risk models in the STsegment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: We studied all consecutive patients with STEMI who underwent PPCI at our institution between 2006 and 2010 (n=1391). The CRUSADE, ACUITY-HORIZONS, and ACTION risk scores were calculated based on the patients' clinical characteristics. The occurrence of in-hospital major bleeding (defined as the composite of intracranial or intraocular bleeding, access site haemorrhage requiring intervention, reduction in haemoglobin ≥4 g/dl without or ≥3g/dl with overt bleeding source, reoperation for bleeding, or blood transfusion) reached 9.8%. Calibration and discrimination of the three risk models were evaluated by the Hosmer−Lemeshow test and the C-statistic, respectively. We compared the predictive accuracy of the risk scores by the DeLong non-parametric test. Results: Calibration of the three risk scores was adequate, given the non-significant results of Hosmer−Lemeshow test for the three risk models. Discrimination of CRUSADE, ACUITY-HORIZONS, and ACTION models was good (C-statistic 0.77, 0.70, and 0.78, respectively). The CRUSADE and ACTION risk scores had a greater predictive accuracy than the respectively). There was no significant difference between the CRUSADE and ACTION models (z=0.63, p=0.531). Conclusions: The CRUSADE, ACUITY-HORIZONS, and ACTION scores are useful tools for the risk stratification of bleeding in STEMI treated by PPCI. Our findings favour the CRUSADE and ACTION risk models over the ACUITY-HORIZONS risk score.

Incremental Value of the CRUSADE, ACUITY, and HAS‐BLED Risk Scores for the Prediction of Hemorrhagic Events After Coronary Stent Implantation in Patients Undergoing Long or Short Duration of Dual Antiplatelet Therapy

“…Among the risk scores explored, we found CRUSADE to have a better predictive profile for major bleeding compared with HAS‐BLED and a similar profile compared to ACUITY. This observation is consistent with some previous studies and with the European Society of Cardiology guidelines that recommended the CRUSADE score for bleeding risk stratification in non–ST‐segment elevation MI 9, 15, 16. It might be speculated that the set of covariates used to predict bleeding risk for the CRUSADE score better reflects the bleeding risk in patients undergoing stent implantation and subsequent DAPT.…”

Discontinuation of Dual Antiplatelet Therapy Over 12 Months after Acute Coronary Syndromes Increases Risk for Adverse Events in Patients Treated with Percutaneous Coronary Intervention: Systematic Review and Meta‐Analysis

“…Moreover, a “selection bias” could have occurred: patients who remained on DAPT for more than 12 months could represent a higher thrombotic risk subgroup (i.e., complex coronary lesions, multiple stents) for which physicians preferred a longer DAPT duration. Another explanation may also be possible: ischemic and hemorrhagic events after an ACS are usually related to similar risk factors, ranging from diabetes to renal function . Physicians managing these patients, or maybe patients themselves, may have stopped DAT due to major or minor bleedings in patients at higher risk also for recurrent ischemic events, consequently increasing their thrombotic risk.…”

“…Another explanation may also be possible: ischemic and hemorrhagic events after an ACS are usually related to similar risk factors, ranging from diabetes to renal function. 47,48 Physicians managing these patients, or maybe patients themselves, may have stopped DAT due to major or minor bleedings in patients at higher risk also for recurrent ischemic events, consequently increasing their thrombotic risk. Another limitation is represented by choice of main outcome: death and rates of rehospitalizations for acute coronary syndromes are not evaluated separately at multivariate analysis, so it was not possible to appraise them separately in our analysis.…”

Predicting and preventing vascular complications following percutaneous coronary intervention in women

“…Estimating post-PCI bleeding risk Several studies have developed and validated risk scores to predict post-PCI bleeding events, using both cohort studies and large randomized controlled trials to identify patient and procedural factors associated with an increased bleeding risk [53][54][55][56]. One of the largest and most recent analyses to date is an updated risk model from Rao et al [22] using data from the National Cardiovascular Data Registry CathPCI Registry comprising 1,043,759 PCI procedures performed at 1142 US centers from 2008 to 2011.…”