Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non-ST-Segment Elevation Acute Myocardial Infarction
Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non-ST-Segment Elevation Acute Myocardial Infarction
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DOI：
10.1161/circulationaha.109.925594
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发表时间：
2010-06-08
期刊：
影响因子：
37.8
通讯作者：
Ramon Gonzalez-Juanatey, Jose
中科院分区：
文献类型：
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作者：
Abu-Assi, Emad;Maria Gracia-Acuna, Jose;Ramon Gonzalez-Juanatey, Jose
背景-早期实施ACC/AHA指南对不稳定型心绞痛患者进行快速风险分层是否能抑制不良结局（CRUSADE）模型提供了一种风险评分，可预测因非ST段抬高急性心肌梗死住院患者发生大出血的可能性。本工作的目的是评估该模型在当代队列的非ST段抬高急性心肌梗死住院患者在Spains.Methods和结果的研究对象是782例连续入住我们的中心2004年2月至2009年6月与非ST段抬高急性心肌梗死。对于每例患者，我们计算CRUSADE风险评分，并分别通过C统计量和Hosmer-Lemeshow拟合优度检验评估其区分度和校准。CRUSADE风险评分的性能在整个患者人群和接受或未接受≥ 2种抗血栓药物治疗的患者组以及接受或未接受心导管插入术的患者组中进行评价。中位CRUSADE评分为30分（范围：18 - 45）。共有657例患者（84%）接受了≥ 2种抗血栓药物治疗，其中609例（92.7%）接受了心导管插入术。大出血的总发生率为9.5%。该发生率随风险类别的增加而增加：极低，1.5%;低，4.3%;中度，7.8%;高，11.8%;非常高，28.9%（P= 2抗血栓药物，对于接受或未接受心导管插入术的>= 2抗血栓药物治疗的亚组，CRUSADE评分显示出足够的校准和极好的区分能力（Hosmer-Lemeshow P>0.3，C值分别为0.82、0.80、0.70和0.80）。然而，它表现出很小的能力，以区分出血风险的患者治疗>= 2抗血栓药物谁没有经历心导管插入术（C=0.56）。结论CRUSADE风险评分普遍验证，并发现是有用的西班牙队列的患者治疗或不治疗>= 2抗血栓药物和治疗或不治疗>= 2抗血栓药物谁接受心导管插入术。需要更多的研究来阐明CRUSADE评分在接受≥ 2种抗血栓药物治疗且未接受心导管插入术的亚组中的有效性。（循环。2010; 121：2419-2426）。
Background-The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) model provides a risk score that predicts the likelihood of major bleeding in patients hospitalized for non-ST-elevation acute myocardial infarction. The aim of the present work was to evaluate the performance of this model in a contemporary cohort of patients hospitalized for non-ST-elevation acute myocardial infarction in Spain.Methods and Results-The study subjects were 782 consecutive patients admitted to our center between February 2004 and June 2009 with non-ST-elevation acute myocardial infarction. For each patient, we calculated the CRUSADE risk score and evaluated its discrimination and calibration by the C statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The performance of the CRUSADE risk score was evaluated for the patient population as a whole and for groups of patients treated with or without >= 2 antithrombotic medications and who underwent cardiac catheterization or not. The median CRUSADE score was 30 points (range, 18 to 45). A total of 657 patients (84%) were treated with >= 2 antithrombotic, of whom 609 (92.7%) underwent cardiac catheterization. The overall incidence of major bleeding was 9.5%. This incidence increased with the risk category: very low, 1.5%; low, 4.3%; moderate, 7.8%; high, 11.8%; and very high, 28.9% (P= 2 antithrombotics, and for the subgroup treated with >= 2 antithrombotics who did or did not undergo cardiac catheterization, the CRUSADE score showed adequate calibration and excellent discriminatory capacity (Hosmer-Lemeshow P>0.3 and C values of 0.82, 0.80, 0.70, and 0.80, respectively). However, it showed little capacity to discriminate bleeding risk in patients treated with >= 2 antithrombotics who did not undergo cardiac catheterization (C=0.56).Conclusions-The CRUSADE risk score was generally validated and found to be useful in a Spanish cohort of patients treated with or without >= 2 antithrombotics and in those treated with or without >= 2 antithrombotics who underwent cardiac catheterization. More studies are needed to clarify the validity of the CRUSADE score in the subgroup treated with >= 2 antithrombotics who do not undergo cardiac catheterization. (Circulation. 2010; 121: 2419-2426.)