Interventional Cardiology Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non–ST-Segment Elevation Acute Myocardial Infarction Emad Abu-Assi, MD; Jose ´ Marı ´a Gracı ´a-Acun ˜a, MD, PhD; Ignacio Ferreira-Gonza ´lez, MD, PhD; Carlos Pen ˜a-Gil, MD, PhD; Pilar Gayoso-Diz, MD; Jose ´ Ramo ´n Gonza ´lez-Juanatey, MD, PhD Background—The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) model provides a risk score that predicts the likelihood of major bleeding in patients hospitalized for non–ST-elevation acute myocardial infarction. The aim of the present work was to evaluate the performance of this model in a contemporary cohort of patients hospitalized for non–ST-elevation acute myocardial infarction in Spain. Methods and Results—The study subjects were 782 consecutive patients admitted to our center between February 2004 and June 2009 with non–ST-elevation acute myocardial infarction. For each patient, we calculated the CRUSADE risk score and evaluated its discrimination and calibration by the C statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The performance of the CRUSADE risk score was evaluated for the patient population as a whole and for groups of patients treated with or without 2 antithrombotic medications and who underwent cardiac catheterization or not. The median CRUSADE score was 30 points (range, 18 to 45). A total of 657 patients (84%) were treated with 2 antithrombotic, of whom 609 (92.7%) underwent cardiac catheterization. The overall incidence of major bleeding was 9.5%. This incidence increased with the risk category: very low, 1.5%; low, 4.3%; moderate, 7.8%; high, 11.8%; and very high, 28.9% (P0.001). For the patients as a whole, for the groups treated with or without 2 antithrombotics, and for the subgroup treated with 2 antithrombotics who did or did not undergo cardiac catheterization, the CRUSADE score showed adequate calibration and excellent discriminatory capacity (Hosmer-Lemeshow P0.3 and C values of 0.82, 0.80, 0.70, and 0.80, respectively). However, it showed little capacity to discriminate bleeding risk in patients treated with 2 antithrombotics who did not undergo cardiac catheterization (C=0.56). Conclusions—The CRUSADE risk score was generally validated and found to be useful in a Spanish cohort of patients treated with or without 2 antithrombotics and in those treated with or without 2 antithrombotics who underwent cardiac catheterization. More studies are needed to clarify the validity of the CRUSADE score in the subgroup treated with 2 antithrombotics who do not undergo cardiac catheterization. (Circulation. 2010;121:2419-2426.) Key Words: CRUSADE risk score  major bleeding  myocardial infarction H emorrhagic complications are the most common nonis- chemic complications encountered in patients with acute coronary syndrome (ACS). The frequency of major hemor- rhaging oscillates between 2% and 9% across the spectrum of ACS without ST-segment elevation, largely depending on the definition and the type of treatment used, particularly the dose of antithrombotic agents prescribed and the invasive proce- dures undertaken. 1–3 In ACS, major hemorrhaging is associ- ated with a number of important risks such as death and (re)infarction. 2,4,5 Determining the net benefit of aggressive treatment based on the administration of multiple antithrom- botic therapies and invasive procedures in patients with ACS and estimating a priori the likelihood of hemorrhagic com- plications in relation to the treatment provided can be Received November 23, 2009; accepted March 24, 2010. From the Cardiology Department (E.A.A., J.M.G.-A., C.P.-G., J.R.G.-J.) and Clinical Epidemiology and Biostatistics Unit (P.G.-D.), University Hospital, Santiago de Compostela, and Epidemiology Unit, Cardiology Department, Vall d’Hebron Hospital, Barcelona, and Centro de Investigacio ´n Biome ´dica en Red de Epidemiologı ´a y Salud Pu ´blica, Spain (I.F.-G.). The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/CIRCULATIONAHA.109.925594/DC1. Correspondence to Emad Abu-Assi, Cardiology Department, Hospital Clı ´nico Universitario, Santiago de Compostela, A Corun ˜a, Travesı ´a A. Choupana, s/n Postal Code 15706, Spain. E-mail eabuassi@yahoo.es © 2010 American Heart Association, Inc. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.109.925594 2419 by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from by guest on February 17, 2016 http://circ.ahajournals.org/ Downloaded from