Beta trace protein and Cystatin C add complementary information to CRUSADE bleeding score for predicting bleeding risk in non ST segment elevation acute coronary syndromes

Aims: To evaluate whether Beta trace protein (BTP) and cystatin C (CysC) provide information to the CRUSADE bleeding score for predicting major bleeding (MB); and to compare them to other renal function parameters in non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Methods and results: We included 273 pts with NSTE-ACS. NSTE-ACS was defined as ischemic symptoms lasting ≥10 min and occurring ≤72-h before admission and either ST-segment deviation of ≥1 mm or elevated levels of a cardiac biomarker of necrosis. All blood samples were obtained before coronary angiography within 24-h of admission. The study endpoint was MB (BARC definition criteria: bleeding type 3 to type 5). During a follow-up of 760 days [411-1098], 25 pts (9.2%) had MB. Pts with MB had higher BTP (0.98 [0.71-1.16] vs 0.72 mg/L [0.60-0.91], p=0.002), CysC (1.05 [0.91-1.30] vs 0.90 mg/L [0.75-1.08], p=0.003) and lower eGFR (66±27 vs 80±30 mL/min/1.73m2, p=0.02) than pts without MB; there were no differences in creatinine levels between both groups (p=0.14). In multivariate analyses, a BTP>0.97 mg/L (HR=3.4, 95% CI=1.5-7.9, p=0.004) and CysC>0.96 mg/L (HR=3.1, 95% CI=1.2-7.5, p=0.02) were significant predictors of MB, while eGFR using MDRD equations and creatinine were not. Among subjects with eGFR>60ml/min/1.73m2, those with elevated BTP or CysC had a significantly higher risk for MB (Fig. 1). NRI from the addition of BTP and CysC to CRUSADE were 38% and 21% respectively, while the relative IDI were 12% and 4%. ![Figure][1] Figure 1A, B Conclusion: BTP and CysC were superior to conventional renal parameters for predicting MB, and provide complementary information to the CRUSADE score in NSTE-ACS. Future studies should assess the potential role of incorporating these renal function biomarkers into the bleeding risk scales. [1]: pending:yes