Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain.
Int J Cardiol. 2017 Oct 15;245:1-5. doi: 10.1016/j.ijcard.2017.07.095. Epub 2017 Aug 2.
Acute coronary syndrome (ACS) treatments increase bleeding complications that also impair prognosis. Bleeding risk scores reclassification of actual mortality risk estimated by the GRACE score might improve overall estimation.
Observational and prospective study of all ACS patients admitted in two hospitals. Mortality risk was assessed by the GRACE score and bleeding risk by the CRUSADE score. We analyzed the net reclassification improvement (NRI) of adding the CRUSADE score to the GRACE score.
We included 6997 patients, mean age 67.4 (12.9), 38.0% ST-elevation ACS, mean GRACE score 145.2 (39.9). The percentage of patients with CRUSADE score >20 or >50 increased as the GRACE score was higher. Hospital mortality was 5.3% and the addition of the CRUSADE score reclassified a relevant percentage of patients with GRACE score >109; NRI was 3.80% (1.10-6.10). During follow-up, (median 53.0months) mortality rate was 22.6% and patients with CRUSADE score >50 had significantly higher mortality rates in all GRACE score categories; NRI was high (46.6%, 95% CI 41.0-53.1). The multivariate analysis outlined the independent predictive value of CRUSADE score >20 or >50 as well as GRACE scores 109-139 and >140.
The addition of the CRUSADE score to the GRACE score improved mortality risk estimation. A CRUSADE score >50 identified patients with higher post-discharge mortality and higher hospital mortality if GRACE score was >109. The CRUSADE score improved hospital and long-term mortality prediction in patients with GRACE score >140. Individual mortality risk estimation should integrate the CRUSADE and GRACE scores.
急性冠状动脉综合征（ACS）的治疗会增加出血并发症，这也会影响预后。出血风险评分可以重新分类 GRACE 评分估计的实际死亡风险，从而提高整体评估效果。
对两家医院收治的所有 ACS 患者进行观察性和前瞻性研究。通过 GRACE 评分评估死亡率风险，通过 CRUSADE 评分评估出血风险。我们分析了添加 CRUSADE 评分对 GRACE 评分的净重新分类改善（NRI）。
我们纳入了 6997 例患者，平均年龄 67.4（12.9）岁，38.0%为 ST 段抬高型 ACS，平均 GRACE 评分为 145.2（39.9）。随着 GRACE 评分的升高，CRUSADE 评分>20 或>50 的患者比例增加。住院死亡率为 5.3%，添加 CRUSADE 评分重新分类了相当一部分 GRACE 评分>109 的患者；NRI 为 3.80%（1.10-6.10）。在随访期间（中位随访时间为 53.0 个月），死亡率为 22.6%，CRUSADE 评分>50 的患者在所有 GRACE 评分类别中死亡率均显著升高；NRI 较高（46.6%，95%CI 41.0-53.1）。多变量分析确定了 CRUSADE 评分>20 或>50 以及 GRACE 评分 109-139 和>140 为独立的预测因素。
将 CRUSADE 评分添加到 GRACE 评分中可以提高死亡率风险估计。如果 GRACE 评分>109，则 CRUSADE 评分>50 可识别出出院后死亡率较高和住院死亡率较高的患者。对于 GRACE 评分>140 的患者，CRUSADE 评分可提高住院和长期死亡率预测。个体死亡率风险评估应综合考虑 CRUSADE 和 GRACE 评分。
