CC BY 4.0 · TH Open 2018; 02(04): e399-e406
DOI: 10.1055/s-0038-1675576
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Comparison of ACUITY, CRUSADE, and GRACE Risk Scales for Predicting Clinical Outcomes in Patients Treated with Dual-Antiplatelet Therapy

Sun Young Choi
1   Department of Biomedical Laboratory Science, Daegu Health College, Daegu, Republic of Korea
Moo Hyun Kim
2   Department of Cardiology, College of Medicine, Dong-A University, Busan, Republic of Korea
Victor Serebruany
3   HeartDrug™ Research Laboratories, Johns Hopkins University, Towson, Maryland, United States
› Author Affiliations
Funding This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI14C1731) and funded by the Ministry of Education, Science and Technology (NNRF-2015R1D1A1A09057025) to M.H.K. Part of this work was supported by the “Brain Pool” program funded by the Korean Ministry of Science and Technology to V.S.
Further Information

Publication History

15 April 2018

17 September 2018

Publication Date:
27 November 2018 (online)


Several reliable scales have been proposed for the management and prognosis in patients with acute coronary syndromes (ACS) treated with dual-antiplatelet therapy (DAPT). We sought to compare the performance of three conventional risk scores to predict major bleeding (MB; such as ACUITY or CRUSADE), or major adverse cardiovascular event (MACE for GRACE). This study included 904 consecutive post-ACS patients from the single Korean study center who underwent coronary interventions, and were treated with DAPT. All three scores were calculated based on admission data. MB and MACE were collected at 30-day and 1-year follow-ups. MB was defined according to the Bleeding Academic Research Consortium (BARC) criteria (types 3–5), and MACE included all-cause death, myocardial infarction, target vessel revascularization, and stroke. MB occurred in 114 patients (12.6%) during 30 days, and 65 patients (7.2%) from 30 days till 1-year follow-up. MACE occurred in 28 (3.1%) and 72 (8.0%) patients during 30 and 30 days till 1 year, respectively. For 30 days MB, the discriminatory ability of ACUITY (AUC: 0.83, 95% CI: 0.81–0.86) and CRUSADE (AUC: 0.82, 95% CI: 0.79–0.84) was similar, and more reliable than GRACE (AUC: 0.74, 95% CI: 0.71–0.77; p < 0.0001 and p = 0.002, respectively). The predictive value for 1-year MB was similar between ACUITY (AUC: 0.75, 95% CI: 0.72–0.78, p < 0.0001), CRUSADE (AUC: 0.70, 95% CI: 0.70–0.73, p < 0.0001), and GRACE (AUC: 0.70, 95% CI: 0.67–0.73, p < 0.0001) classifications. All three risk scales exhibited similar prediction for 30-day and 1-year MACE. We conclude that ACUITY and CRUSADE scores were superior to GRACE in predicting 30-day MB. However, all three risk scales were similarly useful for long-term MB, and MACE assessment.