Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome.
OBJECTIVE
Haemorrhagic complications are strongly linked with adverse outcomes in acute coronary syndrome (ACS) patients. Various risk scores (RS) are available to predict bleeding risk in these patients. We compared the performance of three contemporary bleeding RS in ACS.


METHODS
We studied 4500 consecutive patients with ACS. We calculated the ACTION, CRUSADE, and Mehran et al. (2010) bleeding RS, and evaluated their performance for predicting their own major bleeding events and TIMI serious (major or minor) bleeding episodes, in patients with either non-ST-elevation ACS (NSTEACS) or ST-elevation myocardial infarction (STEMI). Calibration (Hosmer-Lemeshow test, HL) and discrimination (c-statistic) for the three RS were computed and compared.


RESULTS
For RS-specific major bleeding, ACTION and CRUSADE showed the best prognostic discrimination in STEMI (c=0.734 and 0.791, respectively; p=0.04), and in NSTEACS (c=0.791 and 0.810; p=0.4); being CRUSADE significantly superior to Mehran et al. in both ACS types (p<0.05). All RS performed well in patients undergoing coronary arteriography using either a radial or femoral approach (all c≥0.718); however, their discriminative capacity was modest in patients not undergoing coronary arteriography and in those previously on oral anticoagulant (all c<0.70). For TIMI serious bleeding, ACTION and CRUSADE displayed the highest c-index values in both STEMI (0.724 and 0.703, respectively; p=0.3) and NSTEACS (c=0.733 and 0.744, respectively; p=0.6); however, calibration of ACTION was poor in both ACS types (HL p<0.05).


CONCLUSIONS
Of contemporary bleeding RS, the CRUSADE score was found to be the most accurate quantitative tool for NSTEACS and STEMI patients undergoing coronary arteriography.
Hospital Clínico de Santiago, Santiago de Compostela, Spain.
Emad
E
Abu-Assi
Sergio
S
Raposeiras-Roubin
Pamela
P
Lear
Pilar
P
Cabanas-Grandío
Mar
M
Girondo
Marta
M
Rodríguez-Cordero
Eva
E
Pereira-López
Santiago Gestal
SG
Romaní
Cristina
C
González-Cambeiro
Belén
B
Alvarez-Alvarez
José María
JM
García-Acuña
José Ramón
JR
González-Juanatey
Acute coronary syndrome; haemorrhage; risk score