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

被引:776
作者
Subherwal, Sumeet
Bach, Richard G. [1 ]
Chen, Anita Y. [2 ]
Gage, Brian F.
Rao, Sunil V. [2 ]
Newby, L. Kristin [2 ]
Wang, Tracy Y. [2 ]
Gibler, W. Brian [3 ]
Ohman, E. Magnus [2 ]
Roe, Matthew T. [2 ]
Pollack, Charles V., Jr. [4 ]
Peterson, Eric D. [2 ]
Alexander, Karen P. [2 ]
机构
[1] Washington Univ, Sch Med, Div Cardiovasc, St Louis, MO 63110 USA
[2] Duke Clin Res Inst, Durham, NC USA
[3] Univ Cincinnati, Cincinnati, OH USA
[4] Penn Hosp, Philadelphia, PA 19107 USA
关键词
myocardial infarction; bleeding; risk assessment; ACUTE CORONARY SYNDROMES; CREATININE CLEARANCE; CLINICAL-OUTCOMES; ENOXAPARIN; IMPACT; INTERVENTION; TOLERABILITY; BIVALIRUDIN; ANGIOPLASTY; CLOPIDOGREL;
D O I
10.1161/CIRCULATIONAHA.108.828541
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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. Methods and Results-We developed (n=71277) and validated (n=17857) 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 <= 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: >= 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. (Circulation. 2009;119:1873-1882.)
引用
收藏
页码:1873 / 1882
页数:10
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