Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Neurology, Duke Clinical Research Institute, Durham, NC 27705, USA.
Chin Med J (Engl). 2018 Feb 5;131(3):262-267. doi: 10.4103/0366-6999.223858.
There is scanty evidence concerning the ability of Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines (CRUSADE) and Acute Catheterization and Urgent Intervention Triage Strategy and Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (ACUITY-HORIZONS) scores to predict out-of-hospital bleeding risk after percutaneous coronary interventions (PCIs) with drug-eluting stents (DES) in patients receiving dual antiplatelet therapy. We aimed to assess and compare the long-term prognostic value of these scores regarding out-of-hospital bleeding risk in such patients.
We performed a prospective observational study of 10,724 patients undergoing PCI between January and December 2013 in Fuwai Hospital, China. All patients were followed up for 2 years and evaluated through the Fuwai Hospital Follow-up Center. Major bleeding was defined as Types 2, 3, and 5 according to Bleeding Academic Research Consortium Definition criteria.
During a 2-year follow-up, 245 of 9782 patients (2.5%) had major bleeding (MB). CRUSADE (21.00 [12.00, 29.75] vs. 18.00 [11.00, 26.00], P < 0.001) and ACUITY-HORIZONS (9.00 [3.00, 14.00] vs. 6.00 [3.00, 12.00], P < 0.001) risk scores were both significantly higher in the MB than non-MB groups. Both scores showed a moderate predictive value for MB in the whole study cohort (area under the receiver-operating characteristics curve [AUROC], 0.565; 95% confidence interval [CI], 0.529-0.601, P = 0.001; AUROC, 0.566; 95% CI, 0.529-0.603, P < 0.001, respectively) and in the acute coronary syndrome (ACS) subgroup (AUROC: 0.579, 95% CI: 0.531-0.627, P = 0.001; AUROC, 0.591; 95% CI, 0.544-0.638, P < 0.001, respectively). However, neither score was a significant predictor in the non-ACS subgroup (P > 0.05). The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup.
CRUSADE and ACUITY-HORIZONS scores showed statistically significant but relatively limited long-term prognostic value for out-of-hospital MB after PCI with DES in a cohort of Chinese patients. The value of CRUSADE and ACUITY-HORIZONS scores did not differ significantly (P > 0.05) in the whole cohort, ACS subgroup, or non-ACS subgroup.
在接受双联抗血小板治疗的患者中，经皮冠状动脉介入治疗（PCI）置入药物洗脱支架（DES）后，关于 CRUSADE（不稳定型心绞痛患者快速危险分层以尽早实施 ACC/AHA 指南以抑制不良结局）和急性导管插入术和紧急介入治疗分类策略和通过血管重建和支架使急性心肌梗死结局得到协调（ACUITY-HORIZONS）评分预测院外出血风险的能力方面，相关证据较少。我们旨在评估和比较这些评分在这些患者中的长期预后价值，以预测院外出血风险。
我们对 2013 年 1 月至 12 月期间在中国阜外医院接受 PCI 的 10724 例患者进行了前瞻性观察性研究。所有患者均随访 2 年，并通过阜外医院随访中心进行评估。主要出血根据 Bleeding Academic Research Consortium 定义标准定义为 2 型、3 型和 5 型。
在 2 年的随访期间，9782 例患者中有 245 例（2.5%）发生主要出血（MB）。CRUSADE（21.00[12.00，29.75] vs. 18.00[11.00，26.00]，P<0.001）和 ACUITY-HORIZONS（9.00[3.00，14.00] vs. 6.00[3.00，12.00]，P<0.001）评分在 MB 组均明显高于非 MB 组。这两个评分在整个研究队列中对 MB 都有中度预测价值（接受者操作特征曲线下面积 [AUROC]，0.565；95%置信区间 [CI]，0.529-0.601，P=0.001；AUROC，0.566；95%CI，0.529-0.603，P<0.001），在急性冠脉综合征（ACS）亚组中也是如此（AUROC：0.579，95%CI：0.531-0.627，P=0.001；AUROC，0.591；95%CI，0.544-0.638，P<0.001）。然而，在非 ACS 亚组中，这两个评分均不是显著的预测因子（P>0.05）。在整个队列、ACS 亚组或非 ACS 亚组中，CRUSADE 和 ACUITY-HORIZONS 评分的价值没有显著差异（P>0.05）。
在接受 PCI 置入 DES 的中国患者队列中，CRUSADE 和 ACUITY-HORIZONS 评分对 PCI 术后院外 MB 有统计学意义但相对有限的长期预后价值。在整个队列、ACS 亚组或非 ACS 亚组中，CRUSADE 和 ACUITY-HORIZONS 评分的价值没有显著差异（P>0.05）。
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