Emergency Medicine Cardiac Research and Education Group


CRUSADE
CRUSADE Quality Improvement Initiative

Launched in 2001, CRUSADE is a national quality improvement initiative, designed to increase the practice of evidence-based medicine for patients diagnosed with non-ST segment elevation acute coronary syndromes (NSTE ACS) (i.e., unstable angina or NSTE myocardial infarction).

Through a continuous cycle of data collection, performance feedback and quality improvement interventions, over 500 participating sites in the US are consistently improving the standard of care for patients with NSTE ACS. Because of the dedication of the participating hospitals to this mission, over 200,000 cases have been submitted to the CRUSADE database. For more information visit the CRUSADE website.

In 2007, a milestone occurred. Duke Clinical Research Institute and its CRUSADE leadership joined forces with the American College of Cardiology Foundation's National Cardiovascular Data Registry (NCDR™) to launch a new initiative to improve the safety and outcomes for patients with ACS through the development of NCDR-ACTION™. This initiative will combine the data collection and quality reporting features of two leading national ACS registries to create the largest and most comprehensive national cardiovascular patient database ever developed. For more information visit the NCDR-ACTION Registry™ visit the website or call 800-257-4737 for more information.



Association Between Admission Neutrophil to Lymphocyte Ratio and Outcomes in Patients With Acute Coronary Syndrome



Am J Cardiol 2008; 102: 653-657 View citation

The neutrophil/lymphocyte ratio (NLR) has recently been described as a predictor of mortality in patients who undergo percutaneous coronary intervention. The aim of this study was to investigate the utility of admission NLRs in predicting outcomes in patients with acute coronary syndromes (ACS). A total of 2,833 patients admitted to the University of Michigan Health System with diagnoses of ACS from December 1998 to October 2004 were followed. Patients were divided into tertiles according to NLR. The primary end point was all-cause in-hospital and 6-month mortality. The ACS cohort comprised 564 patients with ST-segment elevation myocardial infarctions and 2,269 patients with non–ST-segment elevation ACS. Patients in tertile 3 had higher in-hospital (8.5% vs 1.8%) and 6-month (11.5% vs 2.5%) mortality compared with those in tertile 1 (p <0.001). After adjusting for Global Registry of Acute Coronary Events risk profile, patients in the highest tertile were at an exaggerated risk for in-hospital (odds ratio 2.04, p = 0.013) and 6-month (odds ratio 3.88, p <0.001) mortality. Admission NLR is an independent predictor of in-hospital and 6-month mortality in patients with ACS. This relatively inexpensive marker of inflammation can aid in the risk stratification and prognosis of patients diagnosed with ACS.


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