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CRUSADE: Is it still a good score to predict bleeding inacute coronary syndrome?

2018-11Journal article Open access
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dc.contributor.authorBento, D.
dc.contributor.authorMarques, N.
dc.contributor.authorGuedes, J.
dc.contributor.authorAzevedo, Pedro
dc.contributor.authorAmado, José
dc.contributor.authorSantos, W.
dc.contributor.authorBispo. J.
dc.contributor.authorMimoso, J.
dc.contributor.authorJesus, I.
dc.contributor.authorSilva, D.
dc.date.accessioned2017-04-07T15:56:14Z
dc.date.available2017-04-07T15:56:14Z
dc.date.issued2018-11
dc.description.abstractIntroduction: Major bleeding is a serious complication of acute coronary syndrome (ACS) andis associated with a worse prognosis. The CRUSADE bleeding score is used to stratify the risk ofmajor bleeding in ACS.Objective: To assess the predictive ability of the CRUSADE score in a contemporary ACS popu-lation.Methods: In a single-center retrospective study of 2818 patients admitted with ACS, the CRU-SADE score was calculated for each patient and its discrimination and goodness of fit wereassessed by the area under the receiver operating characteristic curve (AUC) and by the Hosmer-Lemeshow test, respectively. Predictors of in-hospital major bleeding (IHMB) were determined.Results: The IHMB rate was 1.8%, significantly lower than predicted by the CRUSADE score (7.1%,p<0.001). The incidence of IHMB was 0.5% in the very low risk category (rate predicted by thescore 3.1%), 1.5% in the low risk category (5.5%), 1.6% in the moderate risk category (8.6%),5.5% in the high risk category (11.9%), and 4.4% in the very high risk category (19.5%). Thepredictive ability of the CRUSADE score for IHMB was only moderate (AUC 0.73).The in-hospital mortality rate was 4.0%. Advanced age (p=0.027), femoral vascular access(p=0.004), higher heart rate (p=0.047) and ticagrelor use (p=0.027) were independent predictorsof IHMB.Conclusions: The CRUSADE score, although presenting some discriminatory power, significantlyoverestimated the IHMB rate, especially in patients at higher risk. These results questionwhether the CRUSADE score should continue to be used in the stratification of ACS.
dc.description.abstractIntrodução: A hemorragia major (HM) é uma complicação grave da síndrome coronária aguda (SCA) e está associada a pior prognóstico. O score CRUSADE permite estratificar o risco de HMna SCA.Objetivo: Avaliar a capacidade preditiva do score CRUSADE numa populac ̧ão contemporânea deSCA.Métodos: Estudo unicêntrico e retrospetivo com 2.818 doentes admitidos por SCA. O scoreCRUSADE foi calculado para cada doente, a sua discriminac ̧ão e calibrac ̧ão foram avaliadas pelaárea abaixo da curva (AUC) Receiver Operating Characteristic e pelo teste Hosmer-Lemeshow,respetivamente. Foram determinados os preditores de HM intra-hospitalar (HMIH).Resultados: A taxa de HMIH foi de 1.8%, valor significativamente inferior ao estimado peloscore CRUSADE (7,1%, p<0,001). A incidência de HMIH nas diferentes categorias foi de 0,5% nade muito baixo risco (taxa estimada pelo score de 3,1%); 1,5% na de baixo (estimada de 5,5%);1,6% na de moderado (estimada de 8,6%); 5,5% na de elevado (estimada de 11,9%) e 4,4% na demuito elevado (estimada de 19,5%). A capacidade preditora do score CRUSADE para HMIH foiapenas moderada (AUC 0,73). A taxa de mortalidade intra-hospitalar foi de 4,0%. A idade maisavanc ̧ada (p=0,027), o acesso vascular femoral (p=0,004), a frequência cardíaca mais elevada(p=0,047) e o ticagrelor (p=0,027) foram preditores independentes de HMIH.Conclusão: O score CRUSADE, apesar de apresentar algum poder discriminatório, sobrestimou de forma significativa a taxa de HMIH, principalmente nos doentes de maior risco. Esses resultados questionam se o score CRUSADE deverá continuar a ser usado na estratificação da SCA
dc.identifier.issn2174-2049
dc.identifier.urihttp://hdl.handle.net/10400.1/9352
dc.language.isoeng
dc.peerreviewedyes
dc.publisherElsevier España
dc.relation.isbasedonWOS:000383869502626
dc.subjectMajor bleeding
dc.subjectAcute coronary syndrome
dc.subjectCRUSADE bleeding score
dc.subjectIn-hospital prognosis
dc.subjectScore CRUSADE
dc.subjectSíndrome coronária aguda
dc.subjectHemorragia major
dc.subjectPrognóstico intra-hospitalar
dc.titleCRUSADE: Is it still a good score to predict bleeding inacute coronary syndrome?
dc.title.alternativeScore CRUSADE: será ainda um bom score para prever a hemorragia na síndrome coronária aguda?
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage897
oaire.citation.issue11
oaire.citation.startPage889
oaire.citation.titleRevista Portuguesa de Cardiologia (English Edition)
oaire.citation.volume37
person.familyNameBento
person.familyNameAzevedo
person.familyNameAmado
person.givenNameDina
person.givenNamePedro
person.givenNameJosé
person.identifier.ciencia-id4317-39DD-FD1D
person.identifier.orcid0000-0001-6383-7228
person.identifier.orcid0000-0002-1464-4785
rcaap.rightsopenAccess
rcaap.typearticle
relation.isAuthorOfPublication7f5dd19b-baed-4cfe-807f-e8bb2267cf74
relation.isAuthorOfPublicationd2ba39e4-18cf-4e76-8a6c-74256900bf2b
relation.isAuthorOfPublicationd9e20f2d-302a-40b4-8833-6d29d872d36d
relation.isAuthorOfPublication.latestForDiscovery7f5dd19b-baed-4cfe-807f-e8bb2267cf74

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