Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Abstract

BackgroundThe ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.ObjectiveTo compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.MethodsThis study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).ResultsMajor bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.ConclusionThe ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

Capítulo 1 - Conceituação, Epidemiologia e Prevenção Primária

“…The proportion decreases among those with complete elementary education (16.7%), being 18.2% among those with complete higher education. 26 However, the ELSA Brazil Study, performed with employees of six Brazilian universities and university-affiliated hospitals with higher schooling, has shown a 35.8% AH prevalence, higher among men. 11 …”

“…A significant association of AH was observed with age, male sex, overweight, central adiposity, sedentary lifestyle during leisure time and work, less than 8 years of schooling, per capita income < 3 minimum wages. 26 …”

Performance of HAS-BLED and CRUSADE risk scores for the prediction of haemorrhagic events in patients with stable coronary artery disease

“…20 In a study by Correia et al, it was reported that the ACUITY scoring system was a better predictor of major bleeding in patients admitted to hospital with ACS compared to the CRUSADE score. 21 These conflicting results suggest that we do not have an ideal scoring system to use on all patients and that new developments are needed in this regard. For this reason, in our study we examined patients with stable coronary artery disease who underwent elective coronary angiography, since there is little data on them and they were often overlooked in previous studies.…”

Evaluation of CRUSADE and ACUITY-HORIZONS Scores for Predicting Long-term Out-of-Hospital Bleeding after Percutaneous Coronary Interventions

“…[ 13 ] reported that CRUSADE scores were better able to predict bleeding risk than ACUITY-HORRIZONS scores in 1391 patients with ST-segment elevation myocardial infarction undergoing PCI; however, Correia et al . [ 14 ] found that ACUITY-HORIZONS scores were better than CRUSADE scores in 519 patients with ACS. These discrepancies may be attributable to differences in definition of bleeding and study patients' characteristics.…”