Raposeiras-Roubín Sergio, Caneiro Queija Berenice, D'Ascenzo Fabrizio, Kinnaird Tim, Ariza-Solé Albert, Manzano-Fernández Sergio, Templin Christian, Velicki Lazar, Xanthopoulou Ioanna, Cerrato Enrico, Quadri Giorgio, Rognoni Andrea, Boccuzzi Giacome, Montabone Andrea, Taha Salma, Durante Alessandro, Gili Sebastiano, Magnani Giulia, Autelli Michele, Grosso Alberto, Flores Blanco Pedro, Garay Alberto, Varbella Ferdinando, Tomassini Francesco, Cobas Paz Rafael, Cespón Fernández María, Muñoz Pousa Isabel, Gallo Diego, Morbiducci Umberto, Domínguez-Rodríguez Alberto, Baz-Alonso José Antonio, Calvo-Iglesias Francisco, Valdés Mariano, Cequier Ángel, Gaita Fiorenzo, Alexopoulos Dimitrios, Íñiguez-Romo Andrés, Abu-Assi Emad
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy.
Rev Esp Cardiol (Engl Ed). 2019 Mar;72(3):215-223. doi: 10.1016/j.rec.2018.06.004. Epub 2018 Jul 18.
The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry.
Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARIS and PARIS). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events.
During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARIS and PARIS scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk.
In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.
PARIS评分可对接受冠状动脉支架置入术和双联抗血小板治疗（DAPT）的缺血性心脏病患者的缺血和出血风险进行联合分层。其在接受替格瑞洛或普拉格雷治疗的急性冠状动脉综合征（ACS）患者中的效用尚不清楚。我们在一项国际注册研究中对这一问题进行了调查。
一项回顾性多中心研究，6个欧洲国家的11个中心自愿参与。我们研究了4310例接受替格瑞洛或普拉格雷DAPT治疗后出院的ACS患者。缺血事件定义为支架血栓形成或自发性心肌梗死，出血事件定义为BARC（出血学术研究联盟）3型或5型出血。计算了两种PARIS评分（PARIS和PARIS）的区分度和校准度。通过缺血和出血事件预测概率之差获得缺血-出血净获益。
在17.2±8.3个月的时间里，发生了80例缺血事件（每年1.9%）和66例出血事件（每年1.6%）。PARIS和PARIS评分分别与缺血事件风险（sHR，1.27；95%CI，1.16 - 1.39）和出血事件风险（sHR，1.14；95%CI，1.01 - 1.30）相关。缺血事件的区分度一般（C指数 = 0.64），出血事件的区分度欠佳（C指数 = 0.56），而两者的校准度均可接受。高出血风险患者的缺血-出血净获益为负（出血事件更多），高缺血风险患者的缺血-出血净获益为正（缺血事件更多）。
在接受替格瑞洛或普拉格雷DAPT治疗的ACS患者中，PARIS模型有助于正确评估缺血-出血风险。
