Honda Yohsuke, Yamawaki Masahiro, Hirano Keisuke, Araki Motoharu, Kobayashi Norihiro, Sakamoto Yasunari, Mori Shinsuke, Tsutumi Masakazu, Takama Takuro, Tokuda Takahiro, Makino Kenji, Shirai Shigemitsu, Ito Yoshiaki
Saiseikai Yokohama City Eastern Hospital, 3-6-1 Shimosueyoshi Tsurumi-ku, Yokohama, Kanagawa, 230-8765, Japan.
Heart Vessels. 2017 Nov;32(11):1285-1295. doi: 10.1007/s00380-017-1000-9. Epub 2017 May 30.
We aimed to create a scoring model to predict post-discharge bleeding (PDB) after drug-eluting stent (DES) implantation in Japanese subjects. We enrolled 1912 consecutive patients undergoing DES implantation (age 70 ± 10 years; 72% male). PDB was defined as a composite of type 5, 3, and 2 bleeding using the Bleeding Academic Research Consortium criteria. A Cox proportional hazard model assessed predictors, and we then derived a clinical model stratifying risk of PDB after DES implantation. Ninety-eight patients (6.7%) experienced PDB; gastrointestinal bleeding (GIB) was most common (n = 66, 67%), followed by intracranial bleeding (n = 24, 25%). PDB was independently associated with age >80 years [risk ratio (RR): 1.89, p < 0.001], hypertension (RR: 1.68, p = 0.03), severe renal dysfunction (RR: 1.56, p = 0.04), anemia on admission (RR: 1.75, p = 0.02), prior history of GIB (RR: 3.49, p < 0.001), NSAIDs use (RR: 2.33, p = 0.03), and introduction of triple antithrombotic therapy (RR: 2.94, p < 0.001). A clinical prediction rule for risk of bleeding events including seven baseline factors was derived. A better predictive ability for PDB was found using this new scoring system than the HAS-BLED score [c statistics, 0.85 (95% CI 0.83-0.87) and c statistics, 0.71 (95% CI 0.69-0.73), respectively; p < 0.001]. This new scoring system including patient characteristics and laboratory variables can identify patients at high risk of PDB after DES implantation.
我们旨在创建一个评分模型，以预测日本患者药物洗脱支架（DES）植入术后的出院后出血（PDB）情况。我们纳入了1912例连续接受DES植入的患者（年龄70±10岁；72%为男性）。PDB被定义为采用出血学术研究联盟标准的5型、3型和2型出血的复合情况。一个Cox比例风险模型评估了预测因素，然后我们得出了一个对DES植入术后PDB风险进行分层的临床模型。98例患者（6.7%）发生了PDB；胃肠道出血（GIB）最为常见（n = 66，67%），其次是颅内出血（n = 24，25%）。PDB与年龄>80岁[风险比（RR）：1.89，p < 0.001]、高血压（RR：1.68，p = 0.03）、严重肾功能不全（RR：1.56，p = 0.04）、入院时贫血（RR：1.75，p = 0.02）、既往GIB病史（RR：3.49，p < 0.001）、使用非甾体抗炎药（NSAIDs）（RR：2.33，p = 0.03）以及采用三联抗栓治疗（RR：2.94，p < 0.001）独立相关。得出了一个包含七个基线因素的出血事件风险临床预测规则。与HAS - BLED评分相比，使用这个新的评分系统对PDB具有更好的预测能力[c统计量分别为0.85（95%可信区间0.83 - 0.87）和c统计量0.71（95%可信区间0.69 - 0.73）；p < 0.001]。这个包含患者特征和实验室变量的新评分系统能够识别DES植入术后发生PDB的高危患者。
