Correia Luis C L, Ferreira Felipe, Kalil Felipe, Silva André, Pereira Luisa, Carvalhal Manuela, Cerqueira Maurício, Lopes Fernanda, Sá Nicole de, Noya-Rabelo Márcia
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, BR.
Arq Bras Cardiol. 2015 Jul;105(1):20-7. doi: 10.5935/abc.20150058. Epub 2015 Jun 2.
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.
To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.
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).
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.
The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.
急性冠状动脉综合征（ACS）中，ACUITY和CRUSADE评分是用于预测主要出血事件的有效模型。然而，这些评分的比较性能尚不清楚。
比较ACUITY和CRUSADE评分在预测ACS期间主要出血事件方面的准确性。
本研究纳入了519例因不稳定型心绞痛、非ST段抬高或ST段抬高型心肌梗死连续入院的患者。根据入院数据计算评分。我们按照出血学术研究联盟（BARC）标准（3型或5型：血流动力学不稳定、需要输血、血红蛋白下降≥3g以及颅内、眼内或致命性出血），考虑住院期间与心脏手术无关的主要出血事件。
31例患者出现主要出血（23例由股动脉穿刺引起，5例为消化道出血，3例为其他部位出血），发生率为6%。虽然两种评分均与出血相关，但与CRUSADE评分（0.62，95%CI = 0.53 - 0.71；p = 0.04）相比，ACUITY评分的C统计量更好（0.73，95%CI = 0.63 - 0.82）。与CRUSADE评分对低风险或高风险的定义相比，ACUITY评分的净重新分类改善为+ 0.19（p = 0.02），这也反映了ACUITY评分的最佳性能。探索性分析表明，ACUITY评分中“年龄”和“ACS类型”变量的存在是其优越性的主要原因。
在因ACS住院的患者中，与CRUSADE评分相比，ACUITY评分是主要出血事件的更好预测指标。
