CRUSADE Score is Superior to Platelet Function Testing for Prediction of Bleeding in Patients Following Coronary Interventions

Hypothetically, diminished platelet reactivity (PR) during dual antiplatelet therapy (DAPT) should cause extra major bleeding events (MBE), although definite evidence is lacking. Multiple scores have been proposed to stratify bleeding risk, but their predictive value during DAPT is unclear. We compared the performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) with PR testing to predict MBE in Korean patients with acute coronary syndrome. We screened 1105, and included 903 consecutive patients who underwent coronary interventions. All patients received DAPT, while MBE were assessed by BARC scale. Admission platelet reactivity was assessed with VerifyNow Analyzer simultaneously with CRUSADE score, and MBE were collected at 1month and at 1year post stenting. There were a total of 113 (11%) MBE at 1month, and extra 41(5%) MBE at 1year. At 1month MBE prediction was superior by CRUSADE score (AUC: 0.816, 95% CI: 0.79 0.84, p<0.0001), compared to PR (AUC: 0.605, 95% CI: 0.572-0.637, p=0.0007). Moreover, CRUSADE score remains the independent predictor of MBE by multivariate analyses (OR=2.94, 95% CI: 2.18-3.96, p<0.0001). At 1year MBE also correlated, but were not significantly different between admission CRUSADE score (AUC: 0.62, 95% CI: 0.58 0.66, p=0.0183) and PR (AUC: 0.674, 95% CI: 0.63-0.71, p=0.002). We conclude that MBE are more common in real life than reported in clinical trials. CRUSADE score was superior to PR testing for predicting short-term, but not 1year MBE in Korean patients undergoing percutaneous coronary intervention and treated with DAPT.