Sánchez-Martínez Marianela, Flores-Blanco Pedro J, López-Cuenca Ángel A, Sánchez-Galián María J, Gómez-Molina Miriam, Cambronero-Sánchez Francisco, Guerrero-Pérez Esther, Valdés Mariano, Januzzi James L, Manzano-Fernández Sergio
Division of Cardiology, University Hospital Virgen de la Arrixaca, School of Medicine, Murcia, Spain.
Department of Internal Medicine, Hospital J.M. Morales Meseguer, Murcia, Spain.
Cardiorenal Med. 2017 Jun;7(3):179-187. doi: 10.1159/000455102. Epub 2017 Feb 17.
Kidney dysfunction (KD) has been associated with increased risk for major bleeding (MB) in patients with acute coronary syndromes (ACS) and may be in part related to an underuse of evidence-based therapies. Our aim was to assess the predictive ability of the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) risk score in patients with concomitant ACS and chronic kidney disease.
We conducted a retrospective analysis of a prospective registry including 1,587 ACS patients. In-hospital MB was prospectively recorded according to the CRUSADE and Bleeding Academic Research Consortium (BARC) criteria. KD was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m.
The predictive ability of the CRUSADE risk score was assessed by discrimination and calibration analyses. A total of 465 (29%) subjects had KD. In multivariate logistic regression analyses, we found high CRUSADE risk score values to be associated with a higher rate of in-hospital MB; however, among patients with KD, it was not associated with BARC MB. Regardless of the MB definition, the predictive ability of the CRUSADE score in patients with KD was lower: area under the curve (AUC) 0.71 versus 0.79, = 0.03 for CRUSADE MB and AUC 0.65 versus 0.75, = 0.02 for BARC MB. Hosmer-Lemeshow analyses showed a good calibration in all renal function subgroups for both MB definitions (all values >0.3).
The CRUSADE risk score shows a lower accuracy for predicting in-hospital MB in KD patients compared to those without KD.
肾功能不全（KD）与急性冠脉综合征（ACS）患者发生大出血（MB）的风险增加相关，且可能部分与循证治疗的使用不足有关。我们的目的是评估不稳定型心绞痛患者通过早期实施美国心脏病学会/美国心脏协会（ACC/AHA）指南抑制不良结局的快速风险分层（CRUSADE）风险评分对合并ACS和慢性肾脏病患者的预测能力。
我们对一个前瞻性注册研究进行了回顾性分析，该研究纳入了1587例ACS患者。根据CRUSADE和出血学术研究联盟（BARC）标准前瞻性记录住院期间的MB情况。KD定义为估计肾小球滤过率<60 mL/min/1.73 m²。
通过鉴别和校准分析评估CRUSADE风险评分的预测能力。共有465例（29%）受试者存在KD。在多因素逻辑回归分析中，我们发现CRUSADE高风险评分值与住院期间MB发生率较高相关；然而，在KD患者中，它与BARC定义的MB无关。无论MB的定义如何，CRUSADE评分在KD患者中的预测能力较低：曲线下面积（AUC）分别为0.71（CRUSADE定义的MB）和0.65（BARC定义的MB），而在无KD患者中分别为0.79和0.75，P值分别为0.03和0.02。Hosmer-Lemeshow分析显示，两种MB定义在所有肾功能亚组中校准良好（所有P值>0.3）。
与无KD的患者相比，CRUSADE风险评分在预测KD患者住院期间MB方面准确性较低。
