Liu Yabin, Lv Fei, Wei Qucheng, Gao Qiyue, Jiang Jun
The Second Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China.
Front Cardiovasc Med. 2023 Jan 11;9:1001261. doi: 10.3389/fcvm.2022.1001261. eCollection 2022.
Risk scores for predicting in-hospital major bleeding in patients with acute myocardial infarction (AMI) are rare. The Swedish web-system for the enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART) score (SS), consisting of five common clinical variables, is a novel model for predicting in-hospital major bleeding. External validation of SS has not yet been completed.
A retrospective study recruiting consecutive East Asian patients diagnosed with AMI was conducted in the Second Affiliated Hospital, Zhejiang University. The primary endpoint was the ability of SS to predict in-hospital major bleeding, which was defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. To validate SS, the discrimination and calibration were assessed in the overall population and several subgroups. The receiver operating characteristic (ROC) curves and the areas under ROC curves (AUCs) were calculated for discrimination. The calibration of SS was evaluated with the unreliability test. A total of 2,841 patients diagnosed with AMI during hospitalization were included, and 1.94% (55) of them experienced in-hospital major bleeding events. The AUC of SS for the whole population was only 0.60 [95% confidence interval (CI), 0.52-0.67], without an acceptable calibration ( = 0.001). Meanwhile, the highest AUC (0.72; 95% CI, 0.61-0.82) of SS for the primary endpoint was found in the diabetes subgroup, with an acceptable calibration ( = 0.87).
This external validation study showed that SS failed to exhibit sufficient accuracy in predicting in-hospital major bleeding among East Asian patients with AMI despite demonstrating acceptable performance in the diabetic subgroup of patients. Studies to uncover optimal prediction tools for in-hospital major bleeding risk in AMI are urgently warranted.
预测急性心肌梗死（AMI）患者院内大出血的风险评分较为少见。瑞典心脏病循证护理强化与发展网络系统评估的推荐治疗方案（SWEDEHEART）评分（SS）由五个常见临床变量组成，是一种预测院内大出血的新型模型。SS的外部验证尚未完成。
在浙江大学医学院附属第二医院开展了一项回顾性研究，纳入连续诊断为AMI的东亚患者。主要终点是SS预测院内大出血的能力，院内大出血定义为出血学术研究联盟（BARC）3型或5型出血。为验证SS，在总体人群和几个亚组中评估了其辨别力和校准度。计算受试者工作特征（ROC）曲线及ROC曲线下面积（AUC）以评估辨别力。采用不可靠性检验评估SS的校准度。共纳入2841例住院期间诊断为AMI的患者，其中1.94%（55例）发生院内大出血事件。SS在总体人群中的AUC仅为0.60[95%置信区间（CI），0.52 - 0.67]，校准度不可接受（P = 0.001）。同时，SS在糖尿病亚组中针对主要终点的AUC最高（0.72；95%CI，0.61 - 0.82），校准度可接受（P = 0.87）。
这项外部验证研究表明，尽管SS在糖尿病亚组患者中表现出可接受的性能，但在预测东亚AMI患者院内大出血方面未能展现出足够的准确性。迫切需要开展研究以发现预测AMI患者院内大出血风险的最佳工具。
