The Performance of CRUSADE and ACUITY Bleeding Risk Scores in Ticagrelor-Treated ACS Patients Who Underwent PCI.

Abstract

The performance of the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) and ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) risk scores for the prediction of major bleeding in ticagrelor-treated acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI) is unknown. The aim of the present study is to validate the performance of both scores in a contemporary Chinese cohort of ACS patients hospitalized for PCI and administrated with ticagrelor. From January 2013 to December 2014, a total of 629 ticagrelor-treated ACS patients who underwent PCI were recruited consecutively. The overall rate of major bleeding defined by the BARC (Bleeding Academic Research Consortium) criteria was 1.7%. This incidence increased with the risk category of both the CRUSADE (very low, 0.6%; low, 1.3%; moderate, 1.1%; high, 7.0%; and very high, 13.0%; p = 0.001) and the ACUITY score (low, 0.6%; moderate, 1.4%; high, 4.9%; and very high, 7.0%; p = 0.003). The CRUSADE score demonstrated adequate calibration and discriminatory capacity for the patients as a whole (HL-p [Hosmer-Lemeshow goodness-of-fit test p-value] >0.3; AUC [area under the curve]: 0.78), with the excellent performance in the subgroups of acute myocardial infarction, men, diabetes and those implanted with more than two DESs (AUC: 0.85, 0.80, 0.93 and 0.93, respectively). For the ACUITY score, adequate calibration and discriminatory capacity could be observed for the whole patients (HL-p > 0.3; AUC: 0.78), with excellent performance for the patients with diabetes or those implanted with more than two DESs (AUC: 0.90 and 0.97, respectively). In conclusion, both CRUSADE and ACUITY risk scores performed adequate discriminatory power for the prediction of major bleeding within 30 days in ticagrelor-treated ACS patients who underwent PCI.