四项 PRECISE-DAPT 评分可识别出出院后大出血风险较高的冠状动脉旁路移植术患者。

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-08-20 DOI:10.1093/ehjcvp/pvae060
Philip Enström, Andreas Martinsson, Mary Rezk, Susanne Nielsen, Erik Björklund, Maya Landenhed-Smith, Emily Pan, Anders Jeppsson
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引用次数: 0

摘要

目的:早期识别出血风险增加的患者可提高个体化抗血栓治疗的可能性。我们在冠状动脉旁路移植术(CABG)患者中验证了 PRECISE-DAPT 评分,该评分最初是用于估计经皮冠状动脉介入术(PCI)后接受双联抗血小板疗法(DAPT)患者的出血风险:纳入 2009-2020 年在瑞典首次接受孤立 CABG 手术并存活至出院的所有患者。根据年龄、估计肾小球滤过率、术前血红蛋白浓度和既往自发性出血情况,计算出出院后接受 DAPT(6 838 人)或抗血小板单药治疗(15 406 人)的患者的四项 PRECISE-DAPT 评分。根据以往的研究,出血风险高的定义是得分≥25,大出血是指因出血而住院。DAPT组有130名患者(1.9%)在术后第一年发生大出血,而单一疗法组有197名患者(1.3%)发生大出血。该评分确定了 32.9% 的 DAPT 组患者和 38.2% 的单一疗法组患者有高出血风险。DAPT和单一疗法的评分ROC曲线下面积分别为0.67(95%CI 0.62-0.72)和0.71(0.67-0.74)。DAPT患者的高出血风险与极低风险的危险比为4.14(2.07-8.26),单一疗法患者的危险比为4.95(2.61-9.39),均为P 结论:PRECISE-DAPT 能识别出 CABG 术后出院后大出血风险增加的患者,准确率中等。其准确性与之前报道的 PCI 术后患者的准确性相当。
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The four-item PRECISE-DAPT score identifies coronary artery bypass grafting patients with increased risk for post-discharge major bleeding.

Aims: Early identification of patients with increased bleeding risk increases the possibility to individualize antithrombotic treatment. We validated the PRECISE-DAPT score, originally developed to estimate bleeding risk in patients on dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), in coronary artery bypass grafting (CABG) patients.

Methods and results: All patients who underwent first time, isolated CABG in Sweden 2009-2020 and survived until discharge were included. The four-item PRECISE-DAPT score, based on age, estimated glomerular filtration rate, preoperative haemoglobin concentration, and previous spontaneous bleeding, was calculated in patients discharged on DAPT (n = 6 838), or antiplatelet monotherapy (n = 15 406). High bleeding risk was defined as a score ≥ 25 in accordance with previous studies and major bleeding as hospitalization due to bleeding. Associations were assessed by C-statistics and Cox regression models.Major bleeding occurred during the first postoperative year in 130 patients (1.9%) in the DAPT group, and in 197 patients (1.3%) in the monotherapy group. The score identified 32.9% of the patients in the DAPT group and 38.2% in monotherapy groups as having high bleeding risk. The area under the ROC-curve for the score was 0.67 (95%CI 0.62-0.72) for DAPT and 0.71 (0.67-0.74) for monotherapy. The hazard ratio for high bleeding risk vs. very low risk was 4.14 (2.07-8.26) for DAPT patients, and 4.95 (2.61-9.39) for monotherapy patients, both p < 0.001.

Conclusions: The PRECISE-DAPT identifies patients with increased risk for major bleeding after discharge following CABG with moderate accuracy. The accuracy is comparable to what previously has been reported for patients after PCI.

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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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