Guerrero Carme, Ariza-Solé Albert, Formiga Francesc, Martínez-Sellés Manuel, Vidán María T, Aboal Jaime
Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona.
Geriatrics Medicine Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona.
J Geriatr Cardiol. 2018 Dec;15(12):713-717. doi: 10.11909/j.issn.1671-5411.2018.12.003.
Elderly patients with acute coronary syndromes (ACS) are at higher risk both for ischemic and bleeding complications. Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting, but no study assessed its applicability in elderly patients. This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice.
The IFFANIAM registry included prospectively patients aged ≥ 75 years with ST segment elevation myocardial infarction (STEMI). Main outcome measured was the incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death). Bleeding risk was classified: (A) according to PRECISE-DAPT values above or not the recommended cut-off point (≥ 25); and (B) according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series (Q1: < 30; Q2: 30-35; Q3: 36-44; Q4: ≥ 45).
A total of 208 patients were included. Mean age was 81.9 ± 4.5 years. Most patients (92.6%) had a PRECISE-DAPT value > 25. A total of 25 patients (12.0%) had bleeding events and 49 patients (23.6%) died. No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point ≥ 25. However, a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series ( = 0.038).
The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk. Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.
老年急性冠状动脉综合征（ACS）患者发生缺血性和出血性并发症的风险更高。当前指南推荐使用PRECISE-DAPT评分对该情况下的出血风险进行分层，但尚无研究评估其在老年患者中的适用性。本研究旨在评估PRECISE-DAPT评分在一系列来自常规临床实践的未选择的老年ACS患者中的表现。
IFFANIAM注册研究前瞻性纳入了年龄≥75岁的ST段抬高型心肌梗死（STEMI）患者。主要观察指标为出院后相关出血的发生率（导致再次入院、输血、干预、停用抗血栓药物或死亡的出血）。出血风险分类如下：（A）根据PRECISE-DAPT值是否高于推荐的切点（≥25）；（B）根据IFFANIAM研究系列中观察到的PRECISE-DAPT值的四分位数（Q1：<30；Q2：30-35；Q3：36-44；Q4：≥45）。
共纳入208例患者。平均年龄为81.9±4.5岁。大多数患者（92.6%）的PRECISE-DAPT值>25。共有25例患者（12.0%）发生出血事件，49例患者（23.6%）死亡。根据推荐的切点≥25，未观察到出血发生率的显著差异。然而，在本系列中观察到的PRECISE-DAPT四分位数范围内，出血发生率呈逐渐上升趋势（P=0.038）。
绝大多数老年患者的PRECISE-DAPT值高于推荐的出血风险切点。对于这些复杂患者，使用不同的切点可能是预测出血风险更合理的方法。
