title: Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score.
abstract: BACKGROUND
  Treatments for non-ST-segment-elevation myocardial infarction (NSTEMI) reduce ischemic events but increase bleeding. Baseline prediction of bleeding risk can complement ischemic risk prediction for optimization of NSTEMI care; however, existing models are not well suited for this purpose.
  
  
  RESULTS
  We developed (n=71 277) and validated (n=17 857) a model that identifies 8 independent baseline predictors of in-hospital major bleeding among community-treated NSTEMI patients enrolled in the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) Quality Improvement Initiative. Model performance was tested by c statistics in the derivation and validation cohorts and according to postadmission treatment (ie, invasive and antithrombotic therapy). The CRUSADE bleeding score (range 1 to 100 points) was created by assignment of weighted integers that corresponded to the coefficient of each variable. The rate of major bleeding increased by bleeding risk score quintiles: 3.1% for those at very low risk (score < or = 20); 5.5% for those at low risk (score 21-30); 8.6% for those at moderate risk (score 31-40); 11.9% for those at high risk (score 41-50); and 19.5% for those at very high risk (score >50; P(trend) <0.001). The c statistics for the major bleeding model (derivation=0.72 and validation=0.71) and risk score (derivation=0.71 and validation=0.70) were similar. The c statistics for the model among treatment subgroups were as follows: > or = 2 antithrombotics=0.72; <2 antithrombotics=0.73; invasive approach=0.73; conservative approach=0.68.
  
  
  CONCLUSIONS
  The CRUSADE bleeding score quantifies risk for in-hospital major bleeding across all postadmission treatments, which enhances baseline risk assessment for NSTEMI care.
authors.affiliation: Cardiovascular Division, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bach
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.forename: Brian F
authors.initials: BF
authors.lastname: Gage
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: L Kristin
authors.initials: LK
authors.lastname: Newby
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.forename: W Brian
authors.initials: WB
authors.lastname: Gibler
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Charles V
authors.initials: CV
authors.lastname: Pollack
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander