CRUSADE bleeding risk score validation for ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

INTRODUCTION: The CRUSADE bleeding risk score (CBRS) accurately predicts major bleeding in non-ST segment elevation myocardial infarction NSTEMI patients. However, little information exists about its application in ST segment elevation myocardial infarction STEMI. We aimed to assess the ability of CBRS to predict in-hospital major bleeding in STEMI patients undergoing primary percutaneous coronary intervention (PPCI). MATERIALS AND METHODS: We prospectively analyzed consecutive STEMI patients undergoing PPCI. Baseline characteristics, in-hospital complications and mid term mortality were recorded. Major bleeding was defined by the CRUSADE definition. Predictive ability of the CBRS was assessed by logistic regression method and the area under the ROC curve (AUC). RESULTS: We included 1064 patients (mean age 63years). Mean CBRS value was 24. Most of patients (740/1064 (69.6%)) were in the two lowest risk quintiles of CBRS. Incidence of in-hospital major bleeding was 33/1064 (3.1%). The rates of in-hospital bleeding across the quintiles of risk groups were 0.4% (very low risk), 2.6% (low), 4.6% (moderate), 7.2% (high), and 13.4% (very high) (p 0.001). AUC was 0.80 (95% CI 0.73-0.87 p 0.001). In patients with radial access angiography (n=621) AUC was 0.81 (95% CI: 0.65-0.97). Mean follow up was 344days. Patients with bleeding events had higher mortality during follow up (HR 6.91; 95% CI 3.72-12.82; p 0.001). CONCLUSIONS: Our patients had a significantly lower bleeding risk as compared to CRUSADE NSTEMI population. CBRS accurately predicted major in-hospital bleeding in this different clinical scenario, including patients with radial artery approach.

Non-invasive assessment of coronary artery bypass grafts and native coronary arteries using 64-slice computed tomography: comparison with invasive coronary angiography.

INTRODUCTION AND OBJECTIVES: Although the diagnostic accuracy of CT in the non-invasive assessment of coronary arteries and grafts is known to be high, only a few studies have investigated the technique's reliability for the combined assessment of native coronary arteries, grafts, and vessels lying distal to anastomoses. The aim of this study was to evaluate the diagnostic accuracy of 64-slice CT for assessing coronary grafts and native coronary arteries. METHODS: In the study, 64-slice CT was used to evaluate 36 patients who had undergone coronary artery bypass graft surgery and had a clinical indication for angiographic graft assessment. The diagnostic accuracy of CT for identifying significant lesions in grafts and native coronary arteries was determined and compared with that of invasive coronary angiography. RESULTS: Of the 103 grafts studied (49 arterial and 54 venous), 96 (93.2%) could be visualized by angiography and 98 (95.1%) by CT. The sensitivity and specificity of CT for detecting significant lesions in grafts were 100% (30/30) and 97% (64/66), respectively, and the positive predictive value (PPV) and negative predictive value (NPV) were 94% and 100%, respectively. For non-revascularized coronary arteries (258 segments), the sensitivity, specificity, PPV and NPV were 94%, 95%, 80%, and 99%, respectively, and for distal vessels, 86%, 97%, 67%, and 99%, respectively. CONCLUSIONS: The diagnostic accuracy of 64-slice CT for evaluating both coronary grafts and native coronary arteries was high.

Valoración no invasiva de injertos aortocoronarios y coronarias nativas con tomografía computarizada de 64 detectores: comparación con la coronariografía invasiva / Non-invasive assessment of coronary artery bypass grafts and native coronary arteries using 64-slice computed tomography: comparison with invasive coronary angiography

Introducción y objetivos. Aunque la tomografía computarizada (TC) multidetector muestra una elevada exactitud diagnóstica en la valoración no invasiva de las arterias coronarias e injertos, son escasos los trabajos que valoren su fiabilidad en el estudio conjunto de vasos nativos, injertos y vasos distales a las anastomosis. El objetivo de este estudio es valorar la exactitud diagnóstica de la TC de 64 detectores en la valoración de injertos coronarios y arterias coronarias nativas. Métodos. Se estudia con TC de 64 detectores a 36 pacientes revascularizados quirúrgicamente e indicación clínica de evaluación angiográfica de sus injertos. Se analizó la exactitud diagnóstica de la TC para la detección de lesiones significativas en los injertos y coronarias nativas comparando sus resultados con los de la coronariografía invasiva. Resultados. De los 103 injertos referidos (49 arteriales y 54 venosos) se visualizaron 96 (93,2%) por coronariografía y 98 (95,1%) por TC. Los valores diagnósticos para los injertos mostraron una sensibilidad del 100% (30/30) y especificidad del 97% (64/66) y valores predictivos positivo (VPP) y negativo (VPN) del 94 y el 100%, respectivamente. Respecto a los vasos nativos no revascularizados (258 segmentos), se obtuvo sensibilidad del 94%, especificidad del 95%, VPP del 80% y VPN del 99%. La sensibilidad y la especificidad de la valoración de vasos distales fueron del 86 y el 97% respectivamente, con VPP del 67% y VPN del 99%. Conclusiones. La TC de 64 detectores presenta una alta exactitud diagnóstica en la valoración de los injertos coronarios y arterias coronarias nativas (AU)

Introduction and objectives. Although the diagnostic accuracy of CT in the non-invasive assessment of coronary arteries and grafts is known to be high, only a few studies have investigated the technique’s reliability for the combined assessment of native coronary arteries, grafts, and vessels lying distal to anastomoses. The aim of this study was to evaluate the diagnostic accuracy of 64-slice CT for assessing coronary grafts and native coronary arteries. Methods. In the study, 64-slice CT was used to evaluate 36 patients who had undergone coronary artery bypass graft surgery and had a clinical indication for angiographic graft assessment. The diagnostic accuracy of CT for identifying significant lesions in grafts and native coronary arteries was determined and compared with that of invasive coronary angiography. Results. Of the 103 grafts studied (49 arterial and 54 venous), 96 (93.2%) could be visualized by angiography and 98 (95.1%) by CT. The sensitivity and specificity of CT for detecting significant lesions in grafts were 100% (30/30) and 97% (64/66), respectively, and the positive predictive value (PPV) and negative predictive value (NPV) were 94% and 100%, respectively. For non-revascularized coronary arteries (258 segments), the sensitivity, specificity, PPV and NPV were 94%, 95%, 80%, and 99%, respectively, and for distal vessels, 86%, 97%, 67%, and 99%, respectively. Conclusions. The diagnostic accuracy of 64-slice CT for evaluating both coronary grafts and native coronary arteries was high (AU)