2种出血评分系统对急性冠脉综合征患者介入治疗后近期出血风险的预测价值比较  

Comparing the performance of PRECISE-DAPT and CRUSADE scoring system for predicting in-hospital hemorrhage in patients with ACS after PCI

作　　者：潘丽婷[1] 严鹏勇[1] 胡文瑛[1] 刘宗军[1] PAN Liting;YAN Pengyong;HU Wenying;LIU Zongjun(Department of Cardiology,Putuo Hospital,Shanghai University of Tranditional Chinese Medicine,Shanghai 200062,Chin)

机构地区：[1]上海中医药大学附属普陀医院心内科,200062

出　　处：《国际心血管病杂志》2018年第3期165-170,共6页International Journal of Cardiovascular Disease

基　　金：2016年度上海中医药大学附属普陀医院院级科研课题(2016316A);上海市医学重点专科建设计划项目-心血管内科(ZK2015A17)

摘　　要：目的:比较PRECISE-DAPT、CRUSADE评分系统对急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后近期出血风险的预测价值。方法:回顾性分析2015年1月至2016年2月因ACS行PCI的患者共417例,其中ST段抬高型心肌梗死234例、非ST段抬高型心肌梗死173例、不稳定心绞痛10例。根据有无出血事件将患者分为出血组(n=98)和未出血组(n=319)。记录患者PRECISE-DAPT、CRUSADE出血评分,logistic回归分析两种出血评分与出血的相关性;受试者工作特征(ROC)曲线分析两种出血评分对出血事件预测的准确性。结果:出血组患者的年龄、>65岁老年人的比例、入院时基线PRECISE-DAPT评分和CRUSADE评分均显著高于未出血组(P均<0.05)。logistic回归分析显示PRECISE-DAPT评分、CRUSADE评分均与出血事件密切相关(PRECISE-DAPT评分OR=1.061,95%CI:1.04~1.084,P<0.001;CRUSADE评分OR=1.041,95%CI:1.026~1.056,P<0.001)。根据PRECISEDAPT评分将患者分成4组:A组(≤10分)107例;B组(11~17分)130例;C组(18~24分)79例;D组(≥25分)101例。Logistic回归分析显示D组发生出血的风险是A组的5.582倍。根据CRUSADE评分将患者分成5组:A组(≤20分)185例;B组(21~30分)107例;C组(31~40分)57例;D组(41~50分)33例,E组(≥51分)35例。Logistic回归分析显示随着CRUSADE评分增高,出血风险增加(E组>D组>C组>B组>A组),E组出血风险是A组的7.262倍。ROC曲线分析显示,PRECISE-DAPT评分的曲线下面积为0.674(95%CI:0.611~0.737),CRUSADE评分的曲线下面积为0.677(95%CI:0.616~0.737),其中PRECISE-DAPT评分≥25分的曲线下面积为0.635(95%CI:0.569~0.702),CRUSADE评分≥41分的曲线下面积为0.587(95%CI:0.519~0.655)。结论:PRECISE-DAPT、CRUSADE出血评分对ACS患者近期出血均有良好的预测价值,其中CRUSADE评分对于院内出血事件的预测作用较好,而PRECISE-DAPT评分的预测作用存在局限性,仅在评分较高的患者中有较好的预测作用。Objective：To investigate the value of PRECISE-DAPT and CRUSADE scoring system in predicting the in-hospital hemorrhage risk in patients with ACS after PCI. Methods：It was a retrospective analysis of 417 patients with ACS underwent PCI in our hospital from January 2015 to February 2016（234 cases of ST-segment elevation myocardial infarction,173 cases of non-ST-segment elevation myocardial infarction,10 cases of unstable angina）,who were divided into bleeding group for98 cases and non-bleeding group for 319 cases according to the BARC hemorrhagic type.The PRECISEDAPT and CRUSADE scores were calculated.The logistic regression analysis and ROC curve were used to analyze the predictive value of the two bleeding risk scores on the bleeding events. Results：The age,proportion of elderly over 65 years old,and the base line PRECISE-DAPT and CRUSADE on admission in bleeding group were significantly higher than those in non-bleeding group（P〈0.05）.The logistic regression analysis showed that the PRECISE-DAPT score（OR=1.061,95%CI：1.04~1.084,P〈0.001）and CRUSADE score（OR=1.041,95%CI：1.026~1.056,P〈0.001）were significantly correlated with bleeding events.All the patients were divided into 4 groups according to the scores of PRECISE-DAPT：group A（≤10）107 cases;group B（11~17）130 cases;group C（18~24）79 cases;group D（≥25）101 cases.Logistic regression analysis showed that the risk of hemorrhage in group D was 5.582 times higher than that in group A（P〈0.001）.The patients were divided into 5 groups according to the scores of CRUSADE：group A（≤20）185 cases;group B（21~30）107 cases;group C（31~40）57 cases;group D（41~50）33 cases;group E（≥51）35 cases.Logistic regression analysis showed that the risk of hemorrhage in group E was 7.262 times higher than that in group A,and the risk of bleeding increased along with the score group by group（E〉D〉C〉B〉A）.ROC curve analysis showed that the area under the curve（AUC）of PRECISE-DAPT was 0.674（95%CI：0.6

关 键 词：急性冠脉综合征 PRECISE-DAPT CRUSADE 

分 类 号：R541.4[医药卫生—心血管疾病]