Predictive performance of adding platelet reactivity on top of CRUSADE score for 1-year bleeding risk in patients with acute coronary syndrome

CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress Adverse outcomes with Early implementation of the ACC/AHA guidelines) risk score can independently predict major bleeding events in patients with non-ST elevation myocardial infarction whereas the discriminative capacity is moderate. Whether adding platelet reactivity on top of CRUSADE score improves the prognostic performance for bleeding remains unclear. 512 patients with acute coronary syndrome (ACS) underwent successful percutaneous coronary intervention were enrolled and 1-year data were available. CRUSADE risk score was calculated at hospital admission and P2Y₁₂ reaction unit (PRU) value was measured by VerifyNow P2Y₁₂ assay. Thirty-five (6.8 %) patients experienced major bleeding events within 1-year follow-up. Patients who developed bleeding complications had higher CRUSADE score (37.5 ± 9.4 vs. 29.0 ± 10.2, p < 0.001) and lower PRU value (149.7 ± 57.1 vs. 196.4 ± 51.4, p < 0.001) than those did not. Both CRUSADE score and platelet reactivity were independently associated with bleeding. Kaplan–Meier analysis showed that patients with high CRUSADE score plus low platelet reactivity had significantly elevated risk for bleeding (HR 7.905, 95 % CI 2.623–23.822, p < 0.001). Compared to CRUSADE score alone, adding platelet reactivity on top of CRUSADE score offered a discriminative increment which was demonstrated by c-statistic (0.827 vs. 0.732, p = 0.011), as well as net reclassification improvement (NRI = 0.258, p < 0.001) and integrated discrimination improvement (IDI = 0.022, p = 0.002). After successful coronary stent implantation in patients with ACS, combining CRUSADE score with platelet reactivity yielded more accurate predictive value for 1-year bleeding risk.