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

Background

The ACUITY and CRUSADE scores are validated models for prediction of majorbleeding events in acute coronary syndrome (ACS). However, the comparativeperformances of these scores are not known.

Objective

To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding eventsduring ACS.

Methods

This study included 519 patients consecutively admitted for unstable angina,non-ST-elevation or ST-elevation myocardial infarction. The scores were calculatedbased on admission data. We considered major bleeding events duringhospitalization and not related to cardiac surgery, according to the BleedingAcademic Research Consortium (BARC) criteria (type 3 or 5: hemodynamicinstability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial,intraocular or fatal bleeding).

Results

Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5digestive, 3 in other sites), an incidence of 6%. While both scores wereassociated 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). Thebest performance of ACUITY was also reflected by a net reclassificationimprovement 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 ‘typeof ACS’ in ACUITY was the main reason for its superiority.

Conclusion

The ACUITY Score is a better predictor of major bleeding when compared with theCRUSADE Score in patients hospitalized for ACS.