Evaluación del puntaje de sangrado “CRUSADE” como prueba diagnóstica para determinar sangrado mayor en pacientes con síndrome coronario agudo sin elevación del ST
Revista Colombiana de Cardiología, 0120-5633, Vol.21, Nro. 1, 2014, p. 13-23
Sociedad Colombiana De Cardiología
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INTRODUCTION: the bleeding-related complications are a major problem in patients admitted with acute coronary syndrome because they are associated with significant morbidity and mortality. "CRUSADE" score, studied and validated, identifies eight predictors of major bleeding in the hospital and is a useful tool to verify the risk of bleeding. OBJECTIVE: to establish the operational characteristics of the bleeding "CRUSADE" score to determine the risk of major bleeding in patients with acute coronary syndrome without ST elevation. Establish which is the best "CRUSADE" score cutoff in our environment, based on the curve of the receiver operating characteristics (ROC). MATERIALS AND METHODS: patients were grouped from July 1, 2011 to November 30, 2011, detailing different variables. The ROC curve was calculated and cut point, sensitivity, specificity, positive and negative predictive values and likelihood ratios were determined. RESULTS: the analysis of 330 patients with mean age 66.5 years and 68.4% of male gender is presented. The average "CRUSADE" score was 27.9. 18.18% had major bleeding, 56.9% unstable angina, and 43.0 % acute myocardial infarction without ST elevation. The area under the curve was determined and the result was 0.8114 (95% CI; 0.75 to 0.87). Using a cutoff point greater than or equal to 35, the results provided a sensitivity of 70 % (95% CI, 55.57 to 82.43), a specificity of 77.41% (95% CI, 72.23 to 82.58), a positive predictive value of 40.78% (95% CI; 30.80 to 50.75 ), a negative predictive value of 92.07% (95% CI; 88.34 to 95.81), a positive likelihood ratio 3.10 (2.35 to 4.08) and a negative likelihood ratio 0.39 (0.26 to 0.57). CONCLUSIONS: the cutoff point for the proposed "CRUSADE" score is greater than or equal to 35. Given the importance of conducting a risk stratification of bleeding, these results serve to recommend the systematic implementation of the "CRUSADE" bleeding score and if this is greater than or equal to 35, establish recommendations to reduce the risk of bleeding and consequently morbidity and mortality.
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