Mugo Peter, Jeilan Mohamed, Msunza Miriam, Orwa James, Ngunga Mzee
Department of Internal Medicine, Aga Khan University Hospital, Nairobi, P.O. Box 30270-00100, Nairobi, Kenya.
Department of Population Health, Aga Khan University, Nairobi, P.O. Box 30270-00100, Nairobi, Kenya.
BMC Cardiovasc Disord. 2025 Feb 28;25(1):137. doi: 10.1186/s12872-024-04434-5.
Dual Antiplatelet Therapy (DAPT) plays an important role in the secondary prevention of ischemic events after treatment for acute coronary syndrome (ACS). The long-term use of DAPT is associated with an increased risk of bleeding, which affects morbidity and mortality. Risk stratification scores have been developed to predict this risk and provide a balance against the risk of ischemic events. The aim of this study was to determine the incidence of bleeding in a cohort of patients in Kenya on DAPT and assess the performance of the PRECISE-DAPT Score in predicting the risk of bleeding.
This was a retrospective study conducted in three hospitals in Kenya among patients on DAPT after ACS between January 2019 and April 2022. We reviewed medical records for demographic and clinical characteristics and conducted telephone interviews to assess bleeding for patients on DAPT for a minimum period of one year. Bleeding events were categorized according to the TIMI criteria for bleeding, and the PRECISE-DAPT Score was calculated using an online calculator. The cumulative one-year incidence of bleeding was calculated and presented as frequencies and percentages. Receiver operating characteristic (ROC) analysis and C-statistics were used to quantify the ability of the PRECISE-DAPT Score to predict bleeding events, whereas calibration was estimated using the Hosmer‒Lemeshow goodness-of-fit test.
A total of 202 patients were enrolled in the study. The study population was predominantly male (n = 156, 77.2%) and African (n = 141, 69.8%), with a median age of 61 years (IQR 52-72). Majority were admitted with ST-Elevation Myocardial infarction (STEMI) (n = 126, 62.4%) and had a mildly reduced left ventricle ejection fraction (n = 124, 61.4%). Fourteen patients (6.9%) met the TIMI criteria for bleeding, of whom 11 (5.4%) had minimal bleeding and 3 (1.5%) had minor bleeding. There was no incidence of major bleeding. The discrimination and calibration of the PRECISE-DAPT Score was good {ROC curve 0.699 (95% CI: 0.564-0.835)} and the Hosmer-Lemeshow goodness-of-fit test (Chi-square, 6.53; p = 0.588), respectively.
The incidence of bleeding was low, with the majority of patients having minimal bleeding that did not require medical intervention. The PRECISE-DAPT Score performed well in predicting bleeding in patients on DAPT.
双联抗血小板治疗（DAPT）在急性冠状动脉综合征（ACS）治疗后的缺血事件二级预防中发挥着重要作用。长期使用DAPT会增加出血风险，这会影响发病率和死亡率。已制定风险分层评分来预测这种风险，并在缺血事件风险之间进行权衡。本研究的目的是确定肯尼亚接受DAPT治疗的一组患者的出血发生率，并评估PRECISE-DAPT评分在预测出血风险方面的表现。
这是一项在肯尼亚三家医院对2019年1月至2022年4月期间接受ACS后DAPT治疗的患者进行的回顾性研究。我们查阅了病历以获取人口统计学和临床特征，并进行电话访谈以评估接受DAPT治疗至少一年的患者的出血情况。出血事件根据TIMI出血标准进行分类，并使用在线计算器计算PRECISE-DAPT评分。计算并以频率和百分比形式呈现累积一年出血发生率。采用受试者工作特征（ROC）分析和C统计量来量化PRECISE-DAPT评分预测出血事件的能力，而校准则使用Hosmer-Lemeshow拟合优度检验进行估计。
共有202名患者纳入研究。研究人群以男性为主（n = 156，77.2%），且多为非洲人（n = 141，69.8%），中位年龄为61岁（四分位间距52 - 72岁）。大多数患者因ST段抬高型心肌梗死（STEMI）入院（n = 126，62.4%），且左心室射血分数轻度降低（n = 124，61.4%）。14名患者（6.9%）符合TIMI出血标准，其中11名（5.4%）为轻微出血，3名（1.5%）为轻度出血。无大出血事件发生。PRECISE-DAPT评分的辨别力和校准良好{ROC曲线0.699（95%CI：0.564 - 0.835）}，Hosmer-Lemeshow拟合优度检验结果为（卡方值，6.53；p = 0.588）。
出血发生率较低，大多数患者为轻微出血，无需医疗干预。PRECISE-DAPT评分在预测接受DAPT治疗患者的出血情况方面表现良好。
