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.