Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Feb;74(2):e13444.
doi: 10.1111/ijcp.13444. Epub 2019 Nov 22.

Risk stratification in acute coronary syndrome: Evaluation of the GRACE and CRUSADE scores in the setting of a tertiary care centre

Katharina Tscherny  1 , Calvin Kienbacher  1 , Verena Fuhrmann  1 , Raphael van Tulder  1 , Wolfgang Schreiber  1 , Harald Herkner  1 , Dominik Roth  1
Affiliations

Risk stratification in acute coronary syndrome: Evaluation of the GRACE and CRUSADE scores in the setting of a tertiary care centre

Katharina Tscherny et al. Int J Clin Pract. 2020 Feb.

Abstract

Objective: Risk assessment plays a decisive role in the management of acute coronary syndrome (ACS). The GRACE and the CRUSADE scores are among the most frequently used risk assessment tools. We aimed to compare the performance of the GRACE and CRUSADE risk scores to predict in-hospital mortality and major bleeding in a contemporary ACS population at a high-volume academic hospital.

Methods: All patients treated for ACS from January 1, 2006 to December 31, 2015 at a tertiary care centre were prospectively enrolled. We calculated GRACE and CRUSADE risk scores. We compared the discrimination capacity of both scores for in-hospital mortality and major bleeding.

Results: In total 4087 patients (1151 [28.2%] female; age 62 ± 14 years) were included. Among these 2218 (54.3%) were diagnosed with ST-elevation myocardial infarction, 113 (2.8%) died in hospital and major bleeding occurred in 65 (1.6%). Discrimination capacity for in-hospital mortality of the GRACE score was superior to the CRUSADE score (receiver operator characteristic area under the curve (AUC) 0.91 (95% CI 0.89-0.93) vs 0.83 (95% CI 0.80-0.86); P < .01). Performance for major bleeding differed but was poor for both scores (AUC 0.71 [0.65-0.76] for GRACE vs 0.61 [0.55-0.68] for CRUSADE; P < .01).

Conclusion: The GRACE score appears to be superior over CRUSADE to predict in-hospital mortality. Major bleeding is rare in the era of primary PCI and performance of both scores for this outcome was poor.

PubMed Disclaimer

Conflict of interest statement

The authors state that they do not have any conflicts of interest.

Figures

Figure 1
Figure 1
Risk category according to GRACE vs CRUSADE score
Figure 2
Figure 2
Discrimination for in‐hospital mortality of the GRACE score (AUC 0.908) was superior to the CRUSADE score (AUC 0.828); P < .01. AUC, area under the curve
Figure 3
Figure 3
Discrimination for major bleeding was moderate for both scores (GRACE AUC 0.706 vs CRUSADE AUC 0.613; P < .01). AUC, area under the curve
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747‐1757. - PubMed
    1. Roffi M, Patrono C, Collet J‐P, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267‐315. - PubMed
    1. Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST‐segment elevation. Eur Heart J. 2012;33(20):2569‐2619. - PubMed
    1. Fox KAA, Dabbous OH, Goldberg RJ, et al. Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ. 2006;333(7578):1091. - PMC - PubMed
    1. Subherwal S, Bach RG, Chen AY, et al. Baseline risk of major bleeding in non‐ST‐segment‐elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) bleeding score. Circulation. 2009;119(14):1873‐1882. - PMC - PubMed