Assessment of the prognostic value of the CRUSADE score in patients with acute coronary syndromes hospitalized in a noninvasive hospital

Abstract Background. The CRUSADE score was created for assessment of bleeding risk in patients with acute coronary syndrome (ACS). However its accuracy was not confirmed in populations of patients treated in Russian hospitals, in noninvasively managed patients, in patients without myocardial infarction (MI). Aim. To assess prognostic value of the CRUSADE score in all pts with ACS, hospitalized in a noninvasive hospital in Russia. Material and methods. Study group comprised 602 patients with ACS admitted to a Moscow community noninvasive hospital (mean age 69.6+/-12.4 years, non-ST elevation ACS - 84.2%). The group was formed by inclusion of 25 consecutively hospitalized patients per month. During hospitalization we registered deaths and all bleeding events classified by TIMI and/or GUSTO criteria. The cut-off of high bleeding risk for CRUSADE score was 40. Results. Any bleedings occurred in 91 patients (15.1%), combination of major and moderate bleedings was registered in 36 patients (6.0%). In high bleeding risk group by CRUSADE score in comparison with non-high risk group bleedings were significantly more frequent (total 20.8 vs. 9.9%, respectively, p=0.0002; major 6.9 vs 1.9%, respectively, p=0.0024; moderate 5.2% vs 1.6%, respectively, p=0.013; combination of major and moderate 9.4 vs 2.9%, respectively, p=0.0007). Sensitivity and specificity of the CRUSADE score for sum of major and moderate bleedings during hospitalization were 77% and 52%, respectively, with area under ROC-curve 0.68. We selected 149 patients (24.8%) who had similar characteristic with patients of the CRUSADE derivation cohort (non-ST elevation MI, no use of vitamin K antagonists, survival and no discharge 48 hours after admission). In this CRUSADE-specific group rate of major/moderate bleedings was significantly higher among high risk compared with other patients (15.6% vs 3.5%, respectively, p=0.016), but for all bleedings difference between these groups was not significant (28.1 vs. 17.6%, p=0.16). In the CRUSADE-specific group sensitivity and specificity of the CRUSADE score for major/moderate bleedings during hospitalization were 81 and 59%, respectively, with area under ROC-curve 0.76. Conclusions. In noninvasively treated ACS patients high risk of bleeding by CRUSADE score was closely associated with occurrence of total as well as major and moderate bleedings. Prognostic accuracy of the CRUSADE score for prediction of major or moderate bleeding during hospitalization was higher in CRUSADE-specific group (patients satisfying criteria of the CRUSADE derivation cohort).