Dannenberg Lisa, Afzal Shazia, Czychy Natalia, M'Pembele René, Zako Saif, Helten Carolin, Mourikis Philipp, Zikeli Dorothee, Ahlbrecht Samantha, Trojovsky Kajetan, Benkhoff Marcel, Barcik Maike, Wolff Georg, Zeus Tobias, Kelm Malte, Polzin Amin
Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
Department of Anesthesiology, University Hospital Duesseldorf, Germany.
Int J Cardiol Heart Vasc. 2021 Mar 13;33:100750. doi: 10.1016/j.ijcha.2021.100750. eCollection 2021 Apr.
Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well.
We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up.
524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01-8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36-9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52-2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12-5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26-3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden's index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24).
In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events.
指南推荐使用PRECISE-DAPT（PD）评分来根据出血风险调整双联抗血小板治疗的持续时间。然而，首次有证据表明PD评分也能预测死亡率和缺血性事件。
我们对994例接受经皮冠状动脉介入治疗（PCI）的患者进行了PD评分研究。将PD评分与临床常用评分进行相关性分析。在一年的随访期间评估主要不良心脑血管事件（MACCE）和心肌梗死溶栓（TIMI）出血情况。
524例患者的PD评分<25，470例患者的PD评分≥25（47%）。PD评分≥25组的严重和轻微出血发生率更高（严重出血：风险比[HR]2.9，95%置信区间[Cl]1.01-8.16，p = 0.049；轻微出血：HR 3.94，95% Cl 1.36-9.19，p = 0.0096）。MACCE、死亡和心肌梗死的发生率也更高（MACCE：HR 2.0，95% Cl 1.52-2.71，p < 0.0001；死亡：HR 3.9，95% Cl 2.12-5.68，p < 0.0001；心肌梗死：HR 2.1，95% Cl 1.26-3.43，p = 0.0041）。两组间中风/短暂性脑缺血发作的发生率无差异。预测严重和轻微出血、MACCE、死亡和心肌梗死的判别能力较高，通过约登指数（YI）计算的临界值几乎相等（严重出血：曲线下面积[AUC]0.66；p = 0.026；YI 32；轻微出血：AUC 0.
