在泰国PCI注册表中验证学术研究联盟的高出血风险定义
Worawut Roongsangmanoon1, Arthit Wongsoasup1, Ply Chichareon2
1Division of Cardiology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak campus, Nakhon Nayok, Thailand.
International journal of cardiology
|July 10, 2023
概括
学术研究联盟 (ARC) 的高出血风险 (HBR) 定义有效地确定了经皮冠状动脉干预 (PCI) 后出血和死亡风险增加的患者. 添加诸如心力衰竭之类的因素提高了对这些不良事件的预测准确度.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 临床风险分层的临床风险分层
背景情况:
- 穿皮冠状动脉干预 (PCI) 后的出血显著影响患者的预后.
- 学术研究联盟 (ARC) 制定了标准,以标准化高出血风险 (HBR) 的定义.
- 这项研究旨在在一个大型,当代的现实世界患者队列中对ARC-HBR定义进行外部验证.
研究的目的:
- 验证ARC-HBR定义,用于识别PCI后出血高风险的患者.
- 评估ARC-HBR定义在出血之外的预后影响,包括血栓事件和死亡率.
- 通过结合额外的临床因素来评估ARC-HBR定义的潜在改进.
主要方法:
- 在泰国PCI注册表中注册的22,741名接受PCI的患者的后期分析 (2018年5月 - 2019年8月).
- 患者被分为ARC-HBR和非ARC-HBR组.
- 主要终点是PCI后12个月大出血的发生率;次要终点包括全因死亡率和心肌梗塞.
主要成果:
- 38.2%的患者符合ARC-HBR标准.
- 与非ARC-HBR组相比,ARC-HBR组的重大出血发病率显著高于ARC-HBR组 (3.3每1000个患者月),而非ARC-HBR组 (1.1每1000个患者月;HR 2.84).
- ARC-HBR患者的全因死亡率 (19.1%与5.2%相比;HR 4.00) 和心肌梗塞的比率明显更高. ARC-HBR得分显示出出血的中度歧视 (C统计值0.674),在添加心力衰竭,先前的心脏病发作,非辐射接入和女性性别后,其改善为0.714.
结论:
- ARC-HBR定义准确地识别了患有PCI后出血和血栓事件风险增加的患者,包括死亡率.
- 多个ARC-HBR标准的存在表明了附加的预后价值.
- 通过增加特定的临床因素来增强ARC-HBR模型,可以提高其对不良结果的预测性能.
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