Key result
ACUITY and CRUSADE scores show similarly modest discrimination for in-hospital bleeding.
Why the study?
The comparative performance of the ACUITY and CRUSADE bleeding risk scores for predicting clinically significant in-hospital bleeding among medically managed patients with acute myocardial infarction in a non-PCI secondary-care setting required evaluation.
Does the ACUITY bleeding risk score improve prediction of clinically significant in-hospital bleeding compared to the CRUSADE score in medically managed patients with acute myocardial infarction?
Cohort (n=842)
No
Does the ACUITY bleeding risk score improve prediction of clinically significant in-hospital bleeding compared to the CRUSADE score in medically managed patients with acute myocardial infarction?
Both ACUITY and CRUSADE bleeding risk scores demonstrated only modest discrimination for predicting in-hospital bleeding in medically managed AMI patients, indicating neither score should be used in isolation to guide clinical management.
Answers are grounded in this paper and cite their sources.
Neither score offers reliable bleeding prediction in medically managed AMI; leaves open need for improved risk tools in this population.
Objectives To compare Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) and Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines (CRUSADE) for predicting clinically significant in-hospital bleeding among patients with acute myocardial infarction managed in a non-percutaneous coronary intervention secondary-care setting. Design Retrospective cohort study. Setting A Malaysian secondary public hospital without on-site percutaneous coronary intervention facilities. Participants Adults with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction admitted during 2024. Main outcome measures Clinically significant in-hospital bleeding; inter-score agreement, discrimination, calibration, threshold-based sensitivity and specificity, category-based net reclassification improvement (NRI) and exploratory simultaneous logistic regression. Results Among 842 patients, 143 (17.0%) experienced bleeding. Agreement between ACUITY and CRUSADE risk categories was fair (κ = 0.270; 95% confidence interval (CI) 0.228–0.313). ACUITY and CRUSADE showed modest discrimination (C-statistics 0.632 and 0.615, respectively; DeLong p = 0.76). Hosmer–Lemeshow p-values were 0.070 for ACUITY and 0.050 for CRUSADE. At cut-offs of ACUITY ≥ 14 and CRUSADE ≥ 40, sensitivity was 76.2% versus 56.6%, and specificity was 46.2% versus 63.4%, respectively; separate paired McNemar tests were significant for both comparisons (both p < 0.001). Global NRI was 0.024 (95% CI −0.061 to 0.108; p = 0.586), indicating no statistically significant overall reclassification improvement. In exploratory simultaneous logistic regression, ACUITY remained associated with bleeding (p = 0.012), whereas CRUSADE did not (p = 0.264). Conclusions Both scores showed modest discrimination. At ACUITY ≥ 14 and CRUSADE ≥ 40, ACUITY was more sensitive and CRUSADE more specific, without evidence of a clear overall advantage. Neither score should be used alone to guide management decisions.
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Kow et al. (2026) conducted a cohort in Acute myocardial infarction (STEMI or NSTEMI) (n=842). ACUITY bleeding risk score vs. CRUSADE bleeding risk score was evaluated on Clinically significant in-hospital bleeding prediction (discrimination via C-statistic) (p=0.76). ACUITY and CRUSADE scores showed modest discrimination for in-hospital bleeding (C-statistics 0.632 vs 0.615; p=0.76), with ACUITY more sensitive (76.2% vs 56.6%) and CRUSADE more specific.
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