Original title: Comparing the predictive validity of three contemporary bleeding risk scores in acute coronary syndrome Reference: European Heart Journal: Acute Cardiovascular Care 2012 1: 222 DOI: 10.1177/2048872612453924

The aim of this study was to compare the validity of the three most widely used scores to predict the risk of bleeding in patients who are hospitalized for acute non-ST, (NSTE-ACS), and ST segment, (STE-ACS), coronary syndromes. 

The ACTION study and Mehran et al score were designed for patients with STE-ACS and NSTE-ACS while CRUSADE was designed only for STE-ACS patients. Although the three scores are similar in some respects, there is no information on the validity of each work or comparison between them. 

This study included 4,500 patients retrospectively diagnosed with acute coronary syndrome who were admitted to hospital between January 2004 and December 2012. TIMI criteria were used to define major or minor bleeding and they were also used in each of the studies (ACTION, CRUSADE and Mehran).

The three scores were useful in predicting the risk of bleeding as defined by each, although the CRUSADE proved more suitable, (c = 0.800, c = 0.783 for ACTION and c = 0748 for Mehran score). Those results prevailed when analyzing the STE-ACS and NSTE-ACS population separately. When using TIMI criteria, the only score suitable was the CRUSADE.

The three scores were not very useful in predicting the risk of bleeding in patients receiving a conservative strategy and in those previously treated with oral anticoagulants (c <0.7).

Conclusion 

The CRUSADE score was superior in predicting the risk of bleeding in the two subpopulations evaluated as well as in the general population.

Editorial Comment

The use of an increasingly powerful antiplatelet to decrease bleeding is going up. Particularly striking is the lack of prediction in patients undergoing a conservative strategy considering that bleeding from the puncture site was low due to 83% utilization of radial access. It is likely that the risk is lower for ischemic patients receiving a conservative strategy and less antiplatelet and antithrombotic drugs. The CRUSADE score, despite having been designed only for STE-ACS, was useful and should complement ischemic risk scores for all patients with acute coronary syndromes prior to admission to the catheterization laboratory.

Courtesy of María Sol Andrés, MD
Hospital Universitario Fundación Favaloro
Argentina

Dra. María Sol Andrés para SOLACI.ORG