title: Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome.
abstract: 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.
  
  
  CONCLUSIONS
  The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Luis C L
authors.initials: LC
authors.lastname: Correia
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Felipe
authors.initials: F
authors.lastname: Ferreira
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Felipe
authors.initials: F
authors.lastname: Kalil
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: André
authors.initials: A
authors.lastname: Silva
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Luisa
authors.initials: L
authors.lastname: Pereira
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Manuela
authors.initials: M
authors.lastname: Carvalhal
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Maurício
authors.initials: M
authors.lastname: Cerqueira
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Lopes
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Nicole de
authors.initials: Nd
authors.lastname: Sá
authors.affiliation: Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
authors.forename: Márcia
authors.initials: M
authors.lastname: Noya-Rabelo
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications; D005260:Female; D006470:Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D011379:Prognosis; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012680:Sensitivity and Specificity; D012737:Sex Factors