Predictive validation of existing bleeding and thromboembolic scores in elderly patients with comorbid atrial fibrillation and acute coronary syndrome  

作　　者：Hong-Hong ZHANG Qi LIU Hai-Jing ZHAO Ya-Ni YU Liu-Yang TIAN Ying-Yue ZHANG Zi-Hao FU Li ZHENG Yue ZHU Yu-Han MA Shuang LI Yang-Yang MA Yu-Qi LIU 

机构地区：[1]Medical School of Chinese PLA,Beijing,China [2]Department of Cardiology&National Clinical Research Center of Geriatrics Disease,Beijing Key Laboratory of Chronic Heart Failure Precision Medicine,National Key Laboratory of Kidney Diseases,Chinese PLA General Hospital,Beijing,China [3]Department of Cardiology,the Sixth Medical Center,Chinese PLA General Hospital,Beijing,China [4]Department of Information,Chinese PLA General Hospital,Beijing,China

出　　处：《Journal of Geriatric Cardiology》2023年第5期330-340,共11页老年心脏病学杂志（英文版）

基　　金：supported by the National Clinical Research Center for Geriatric Diseases(No.NCRCGPLAGH-20190003);the Chinese Cardiovascular Health Alliance-Advanced Fund(No.2019-CCAACCESS-054).

摘　　要：BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in patients.these METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-bleeding and thromboembolic events was calculated and compared.ing RESULTS During the 1-year follow-up,183(14.6%)patients had thromboembolic events,198(15.8%)patients had BARC class≥2 bleeding events,and 61(4.9%)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95%CI:0.611-0.665),ATRIA(C-statistic:0.615,95%CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95%CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95%CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95%CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95%CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95%CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95%CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95%CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-of thromboembolic risk scores was similar.ability CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk score

关 键 词：patients BLEEDING THROMBO 

分 类 号：R541.75[医药卫生—心血管疾病] R541.4[医药卫生—内科学]