评价支架置入患者抗血小板治疗不依从模式与出血评分预测中国经皮冠状动脉介入治疗后患者长期院外出血风险的关系。
Evaluation of the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Bleeding Score for Predicting the Long-term Out-of-hospital Bleeding Risk in Chinese Patients after Percutaneous Coronary Intervention.
机构信息
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 Epidemiology, 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.
出版信息
Chin Med J (Engl). 2018 Jun 20;131(12):1406-1411. doi: 10.4103/0366-6999.228766.
BACKGROUND
The Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients (PARIS) bleeding score is a novel score for predicting the out-of-hospital bleeding risk after percutaneous coronary intervention (PCI). However, whether this score has the same value in non-European and American populations is unclear. This study aimed to assess the PARIS bleeding score's predictive value of bleeding in patients after PCI in the Chinese population.
METHODS
We performed a prospective, observational study of 10,724 patients who underwent PCI from January to December 2013, in Fuwai Hospital, China. We defined the primary end point as major bleeding (MB) according to Bleeding Academic Research Consortium definition criteria including Type 2, 3, or 5. The predictive value of the PARIS bleeding score was assessed with the area under the receiver operating characteristic (AUROC) curve.
RESULTS
Of 9782 patients, 245 (2.50%) MB events occurred during the 2 years of follow-up. The PARIS bleeding score was significantly higher in the MB group than that of non-MB group (4.00 [3.00, 5.00] vs. 3.00 [2.00, 5.00], Z = 3.71, P < 0.001). According to risk stratification of the PARIS bleeding score, the bleeding risk in the intermediate- and high-risk groups was 1.50 times (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.160-1.950; P = 0.002) and 2.27 times higher (HR: 2.27; 95% CI: 1.320-3.900; P = 0.003) than that in the low-risk group. The PARIS bleeding score showed a moderate predictive value for MB in the overall population (AUROC: 0.568, 95% CI: 0.532-0.605; P < 0.001) and acute coronary syndrome (ACS) subgroup (AUROC: 0.578, 95% CI: 0.530-0.626; P = 0.001) and tended to be predictive in the non-ACS subgroup (AUROC: 0.556, 95% CI: 0.501-0.611; P = 0.054).
CONCLUSION
The PARIS bleeding score shows good clinical value for risk stratification and has a significant, but relatively limited, prognostic value for out-of-hospital bleeding in the Chinese population after PCI.
背景
支架患者抗血小板治疗不依从模式（PARIS）出血评分是一种预测经皮冠状动脉介入治疗（PCI）后院外出血风险的新评分。然而，该评分在非欧美人群中是否具有相同的价值尚不清楚。本研究旨在评估 PARIS 出血评分对中国人群 PCI 后患者出血的预测价值。
方法
我们对 2013 年 1 月至 12 月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。我们将主要终点定义为根据出血学术研究联合会（BARC）定义标准发生的主要出血（MB），包括 2 型、3 型或 5 型。采用受试者工作特征（ROC）曲线下面积（AUROC）评估 PARIS 出血评分的预测价值。
结果
在 9782 例患者中，2 年随访期间有 245 例（2.50%）发生 MB 事件。MB 组的 PARIS 出血评分明显高于非 MB 组（4.00[3.00，5.00]比 3.00[2.00，5.00]，Z=3.71，P<0.001）。根据 PARIS 出血评分的危险分层，中危和高危组的出血风险分别为低危组的 1.50 倍（风险比[HR]：1.50；95%置信区间[CI]：1.160-1.950；P=0.002）和 2.27 倍（HR：2.27；95%CI：1.320-3.900；P=0.003）。PARIS 出血评分对总体人群（AUROC：0.568，95%CI：0.532-0.605；P<0.001）和急性冠脉综合征（ACS）亚组（AUROC：0.578，95%CI：0.530-0.626；P=0.001）均具有中等的 MB 预测价值，在非 ACS 亚组也有预测趋势（AUROC：0.556，95%CI：0.501-0.611；P=0.054）。
结论
PARIS 出血评分对风险分层具有良好的临床价值，对中国人群 PCI 后院外出血具有显著但相对有限的预后价值。
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