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Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome
Luis C L Correia1, Felipe Ferreira1, Felipe Kalil1
1Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
Insights
The ACUITY score better predicts major bleeding events in acute coronary syndrome (ACS) patients than the CRUSADE score. This finding aids in risk stratification for ACS patients to improve clinical outcomes.
Area of Science:
- Cardiology
- Clinical Risk Prediction
- Medical Informatics
Background:
- Validated models like ACUITY and CRUSADE scores exist for predicting major bleeding in acute coronary syndrome (ACS).
- Comparative performance data between ACUITY and CRUSADE scores for bleeding risk in ACS is lacking.
Purpose of the Study:
- To directly compare the predictive accuracy of the ACUITY and CRUSADE scores for major bleeding events in hospitalized ACS patients.
Main Methods:
- A cohort of 519 patients admitted for ACS (unstable angina, NSTEMI, STEMI) was analyzed.
- ACUITY and CRUSADE scores were calculated using admission data.
- Major bleeding events during hospitalization, defined by Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5), were recorded.
Main Results:
- The overall incidence of major bleeding was 6% (31 patients).
- The ACUITY score demonstrated superior predictive performance with higher C-statistics (0.73) compared to the CRUSADE score (0.62; p=0.04).
- ACUITY showed a significant net reclassification improvement (+0.19; p=0.02), attributed to its inclusion of 'age' and 'type of ACS' variables.
Conclusions:
- The ACUITY score is a more effective predictor of major bleeding in ACS patients compared to the CRUSADE score.
- This suggests ACUITY may offer improved risk stratification for ACS patients, potentially leading to better management strategies.
Background:
The 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.
Objective:
To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.
Methods:
This 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).
Results:
Major 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.
Conclusion:
The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.
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