Cardiovascular Journal of Africa: Vol 30 No 4 (August 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 4, July/August 2019 198 AFRICA
Performance of HAS-BLED and CRUSADE risk scores
for the prediction of haemorrhagic events in patients
with stable coronary artery disease
Ersin Yildirim, Okkes Uku, Mehmet Nail Bilen, Ozlem Secen
Abstract
We aimed to compare the power of the HAS-BLED and
CRUSADE risk scores in predicting in-hospital bleeding
events in patients with stable coronary artery disease undergo-
ing elective coronary angiography. A total of 405 consecutive
patients were included in the study. The mean HAS-BLED
score was significantly higher (p < 0.001) in the in-hospital
bleeding group. In patients with a HAS-BLED score ≥ 3, the
in-hospital bleeding rate was significantly higher than in those
with a HAS-BLED score < 3 (p < 0.001). Receiver operating
characteristic curve analysis revealed that the HAS-BLED
score was superior in predicting in-hospital bleeding events
compared to the CRUSADE score [area under the curve
(AUC) = 0.684 vs 0.569, respectively, p = 0.002]. Also
in the percutaneous coronary intervention subgroup, the
HAS-BLED score was superior to the CRUSADE score
(AUC = 0.722 vs 0.520, respectively, p = 0.002). We showed
that the HAS-BLED and CRUDASE scores are helpful in
stable patients undergoing elective coronary angiography.
Our results suggest that as a practical, easy-to-implement and
more predictive scoring system, the HAS-BLED score was
more useful for predicting in-hospital bleeding in patients
who did not present with acute coronary syndrome.
Keywords: coronary artery disease, angiography, haemorrhage
Submitted 15/1/19, accepted 26/2/19
Published online 29/3/19
Cardiovasc J Afr 2019; 30: 198–202
DOI: 10.5830/CVJA-2019-014
Bleeding is one of the most common problems in the clinic post
coronary angiography. Many patients undergoing coronary
angiography need antithrombotic treatment and simultaneously
have other co-morbid diseases, leading to more frequent bleeding
problems.1,2 For this reason, a number of risk scores have been
developed in order to predict bleeding events. One of the most
important ones is the CRUSADE risk score, which has been
proven effective for predicting the bleeding risk in patients
presenting with non-ST segment elevation myocardial infarction
(NSTEMI).3 However, a reliable scoring system that can predict
bleeding risk has not been identified yet for patients with stable
coronary artery disease, which constitutes a large part of our
daily practice.
Bleeding is an important cause of co-morbidity, not only
in patients with coronary artery disease, but also for diseases
requiring anticoagulation therapy, such as atrial fibrillation
(AF). In patients with AF, the HAS-BLED bleeding risk score
is one of the most useful scoring systems used to predict the risk
of bleeding. 4 Several studies have previously demonstrated that
the HAS-BLED risk score is an important predictor of bleeding
in patients without AF.5-7 However, a valid bleeding risk score
has not been established in patients undergoing elective coronary
angiography, except for those presenting with acute coronary
syndrome (ACS). In this study, we aimed to determine whether
significant risk scores, such as the HAS-BLED and CRUSADE,
are useful in predicting the risk of in-hospital bleeding in patients
undergoing elective coronary angiography.
Methods
Following ethical committee approval, 405 elective coronary
angiography patients, who were treated in our coronary
angiography unit, were included in the study. Patients with
ST-segment elevation myocardial infarction (STEMI), NSTEMI
patients, those undergoing coronary angiography after sudden
cardiac events, patients with a dynamic ECG or cardiac enzyme
changes, and those with unstable angina were excluded from the
study. Patients with known or suspected stable coronary artery
disease only were included in the study.
Data on the clinical and demographic characteristics of the
patients, history of diabetes mellitus, hypertension, smoking,
stroke or neurological disease, coronary artery disease, cardiac
failure and medications were recorded from the patients and the
patient files. Patients were divided into two groups according
to whether or not bleeding occurred during in-hospital follow
ups. These groups were compared in terms of demographic
characteristics and risk factors.
The groups with and without bleeding were compared
using the HAS-BLED and CRUSADE risk scores. When
the HAS-BLED score was calculated, each of the following
parameters was calculated as one point: hypertension (systolic
blood pressure > 160 mmHg), abnormal renal function [defined
as the presence of chronic dialysis or renal transplantation or
serum creatinine > 2.3 mg/dl (203.32 mmol/l)], abnormal liver
function (defined as chronic hepatic disease or biochemical
Department of Cardiology, University of Health Sciences,
Istanbul Umraniye Education and Research Hospital,
Istanbul, Turkey
Ersin Yildirim, MD,
Department of Cardiology, University of Health Sciences,
Elazig Education and Research Hospital, Elazig, Turkey
Okkes Uku, MD
Mehmet Nail Bilen, MD
Ozlem Secen, MD