Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.
State Key Laboratory of Cardiovascular Disease.
J Atheroscler Thromb. 2022 Apr 1;29(4):502-526. doi: 10.5551/jat.60129. Epub 2021 Mar 20.
The ESC/EACTS myocardial revascularization guidelines recently standardized the definition of patients at high ischemic risk (HIR). However, the ability of ESC/EACTS-HIR criteria to stratify ischemic and bleeding risk in a contemporary real-world East Asian cohort remains unexplored.
A total of 10,167 consecutive patients undergoing PCI from prospective Fuwai PCI Registry (January 2013 to December 2013) were reviewed. ESC/EACTS-HIR features was defined as having at least one of the eight clinical and angiographic characteristics. The primary ischemic endpoint was target vessel failure (cardiac death, target vessel myocardial infarction [MI], or target vessel revascularization [TVR]); bleeding outcome was assessed using the BARC type 2, 3, or 5 bleeding. Median follow-up was 29 months.
Compared with non-HIR patients, HIR patients (n=5,149, 50.6%) were associated with increased risk for target vessel failure (adjusted hazard ratio [HR]: 1.48 [1.25-1.74]) and patient-oriented composite outcome (HR: 1.44 [1.28-1.63]), as well as cardiac death, MI, and TVR. By contrast, the risk of clinically relevant bleeding was not significantly different between the two groups. (HR: 0.84 [0.66-1.06]). Greater than or equal to three implanted stents and diabetic patients with diffuse multivessel coronary disease emerged as independent predictors for long-term adverse outcomes. There was no significant interaction between high bleeding risk (HBR) status and clinical outcomes associated with ESC/EACTS-HIR criteria (all P ＞0.05).
The ESC/EACTS-HIR features identified patients at increased risk of thrombotic events, including cardiac death, but not for clinically relevant bleeding. Importantly, HBR did not modify cardiovascular risk subsequent to patients with ESC/EACTS-HIR features, suggesting its potential clinical applicability in tailoring antithrombotic therapy.
ESC/EACTS 心肌血运重建指南最近将高缺血风险（HIR）患者的定义标准化。然而，ESC/EACTS-HIR 标准在当代东亚真实世界队列中分层缺血和出血风险的能力仍未得到探索。
回顾了前瞻性阜外 PCI 注册研究（2013 年 1 月至 2013 年 12 月）中连续接受 PCI 的 10167 例患者。ESC/EACTS-HIR 特征定义为至少有八项临床和血管造影特征之一。主要缺血终点是靶血管失败（心源性死亡、靶血管心肌梗死[MI]或靶血管血运重建[TVR]）；出血结果使用 BARC 2 型、3 型或 5 型出血进行评估。中位随访时间为 29 个月。
与非 HIR 患者相比，HIR 患者（n=5149，50.6%）发生靶血管失败（调整后的危险比[HR]：1.48[1.25-1.74]）和患者导向的复合结局（HR：1.44[1.28-1.63]）的风险增加，以及心源性死亡、MI 和 TVR。相比之下，两组之间临床相关出血的风险无显著差异。（HR：0.84[0.66-1.06]）。植入支架大于或等于 3 个和患有弥漫性多血管病变的糖尿病患者是长期不良结局的独立预测因素。高出血风险（HBR）状态与 ESC/EACTS-HIR 标准相关的临床结局之间没有显著的相互作用（所有 P ＞0.05）。
ESC/EACTS-HIR 特征确定了发生血栓事件风险增加的患者，包括心源性死亡，但不包括临床相关出血。重要的是，HBR 并未改变 ESC/EACTS-HIR 特征患者的心血管风险，提示其在调整抗血栓治疗方面具有潜在的临床适用性。
