在冠状动脉支架后,ARC-HBR和PRECISE-DAPT高出血风险定义的不一致性和性能
Carl-Emil Lim1, Moa Simonsson2, Björn Pasternak3
1Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
JACC. Cardiovascular interventions
|January 23, 2025
概括
在冠状动脉支架后,ARC-HBR和PRECISE-DAPT对高出血风险的得分显示出显著的不一致. 这两种工具都确定了患有出血和缺血风险增加的患者,但PRECISE-DAPT低估了出血风险.
科学领域:
- 心脏病学 心脏病学
- 临床风险分层的临床风险分层
- 药物治疗 药物治疗
背景情况:
- 高出血风险的定义旨在量身定制冠状动脉支架后的抗血小板治疗.
- ARC-HBR和PRECISE-DAPT得分是确定这些患者的工具.
研究的目的:
- 为了评估ARC-HBR和PRECISE-DAPT分数的实际性能.
- 评估它们在预测出血和缺血事件方面的准确性.
主要方法:
- 来自瑞典斯德哥尔摩 (2013-2018) 的全国性注册数据.
- 包括在双重抗血小板治疗中进行冠状动脉支架后出院的患者.
- 使用ARC-HBR和PRECISE-DAPT进行分类,然后进行1年事件评估 (出血和缺血性).
主要成果:
- 在高出血风险分类中,在ARC-HBR (27%) 和PRECISE-DAPT (38%) 之间观察到实质性的不一致.
- 这两种评分都确定了患有高出血 (BARC 3-5/TIMI大/小) 和缺血风险的患者.
- PRECISE-DAPT得分显示出低估了出血风险.
结论:
- 现有的高出血风险定义在临床实践中显示出重大不一致.
- 被确定为高出血风险的患者也表现出更高的缺血风险.
- 为了提高概括性和准确性,需要完善当前的评分系统.
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