Lyu Si-Qi, Zhu Jun, Wang Juan, Wu Shuang, Zhang Han, Shao Xing-Hui, Yang Yan-Min
Emergency and Critical Care Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Platelets. 2022 Aug 18;33(6):900-910. doi: 10.1080/09537104.2021.2007870. Epub 2022 Feb 1.
This study aims to evaluate the predictive values of the HAS-BLED, ORBIT, ATRIA, REACH, PARIS, and PRECISE-DAPT scores in patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) who received both anticoagulant and antiplatelet therapy. 930 patients were consecutively recruited and followed up for 1 year. The primary endpoints were BARC class ≥3 bleeding and BARC class ≥2 bleeding. BARC class ≥3 bleeding occurred in 36 patients(3.9%), while BARC class ≥2 bleeding was seen in 134 patients (14.4%). The predictive performance of the HAS-BLED score for BARC class ≥3 bleeding was unsatisfactory (c-statistic = 0.575). The discrimination of the ATRIA, ORBIT, PARIS, and PRECISE-DAPT scores was also low-to-moderate. The REACH score was useless in bleeding risk stratification for this population. Multivariable logistic regression indicated that previous bleeding events and hemoglobin were two independent predictors of BARC class ≥3 bleeding. Compared to the HAS-BLED score, the model constructed by previous bleeding events and hemoglobin displayed a significant improvement in bleeding risk prediction [c-statistics: 0.704 vs. 0.575 ( = .008), NRI = 0.662,IDI = 0.049]. In patients with AF and ACS or undergoing PCI who received anticoagulant+antiplatelet therapy, the HAS-BLED, ORBIT, ATRIA, REACH, PARIS, and PRECISE-DAPT scores displayed only low-to-moderate performance in predicting BARC class≥3 bleeding. Future studies are required to develop more reliable scoring systems for bleeding risk evaluation in this population.
本研究旨在评估HAS - BLED、ORBIT、ATRIA、REACH、PARIS和PRECISE - DAPT评分在接受抗凝和抗血小板治疗的心房颤动（AF）合并急性冠状动脉综合征（ACS）或接受经皮冠状动脉介入治疗（PCI）患者中的预测价值。连续纳入930例患者并随访1年。主要终点为BARC 3级及以上出血和BARC 2级及以上出血。36例患者（3.9%）发生BARC 3级及以上出血，134例患者（14.4%）出现BARC 2级及以上出血。HAS - BLED评分对BARC 3级及以上出血的预测性能不理想（c统计量 = 0.575）。ATRIA、ORBIT、PARIS和PRECISE - DAPT评分的辨别能力也为低到中等。REACH评分在该人群出血风险分层中无用。多变量逻辑回归表明，既往出血事件和血红蛋白是BARC 3级及以上出血的两个独立预测因素。与HAS - BLED评分相比，由既往出血事件和血红蛋白构建的模型在出血风险预测方面有显著改善[c统计量：0.704对0.575（P = 0.008），净重新分类指数（NRI）= 0.662，综合判别改善指数（IDI）= 0.049]。在接受抗凝+抗血小板治疗的AF合并ACS或接受PCI的患者中，HAS - BLED、ORBIT、ATRIA、REACH、PARIS和PRECISE - DAPT评分在预测BARC 3级及以上出血方面仅表现出低到中等的性能。未来需要开展更多研究，以开发针对该人群更可靠的出血风险评估评分系统。
