在患有高出血风险的患者中预测出血和缺血风险 (EVOLVE简短DAPT分析)
Nino Mihatov1, Ajay J Kirtane2, Robert Stoler3
1New York-Presbyterian Hospital - Brooklyn Methodist & Weill Cornell Medical College, New York, New York; Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
The American journal of cardiology
|October 1, 2023
概括
高出血风险患者的双重抗血小板治疗 (DAPT) 需要仔细评估风险. 出血风险与缺血风险具有积极的相关性,因此需要标准化模型来做出明智的治疗决策.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在冠状动脉支架后,双重抗血小板治疗 (DAPT) 是标准的.
- 患有高出血风险 (HBR) 的患者对DAPT持续时间构成挑战.
- 在HBR患者中使用SYNERGY支架在EVOLVE简短DAPT研究中进行了评估.
研究的目的:
- 在用SYNERGY支架治疗的HBR患者中确定缺血和出血事件的预测因素.
- 分析预测出血风险与实际事件发生率之间的关系.
- 在复杂的患者群体中为DAPT决策提供信息.
主要方法:
- 对EVOLVE简短DAPT研究数据的特例分析.
- 考克斯比例危险模型用于识别事件预测因素.
- 布雷斯洛方法用于计算预测出血概率.
主要成果:
- 口服抗凝剂和外周血管疾病增加了出血风险.
- 糖尿病和充血性心力衰竭增加了缺血事件的风险.
- 功能缺陷/衰竭与出血和缺血事件有关.
- 在预测的缺血和出血风险之间观察到强烈的正相关性 (R=0.77).
- 预测出血风险≥4%的患者的事件发生率更高.
结论:
- 特定的患者特征预测HBR队列中的缺血和出血事件.
- 增加出血风险与增加缺血风险有关.
- 标准化风险模型对于在HBR患者中指导DAPT决策至关重要.
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