在接受口服抗凝药的TAVI患者中验证VARC-HBR标准
Daniël C Overduin1, Dirk Jan van Ginkel1, Willem L Bor1
1Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
概括
门学术研究联盟高出血风险 (VARC-HBR) 标准有效地确定了经过透气管大动脉植入 (TAVI) 后出血风险的增加. 然而,根据这些标准预测个体风险的程度仅为中等.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 临床试验 临床试验
背景情况:
- 经过导管大动脉植入 (TAVI) 之后,出血是一种常见的并发症.
- 门学术研究联盟高出血风险 (VARC-HBR) 标准是为了确定患有高出血风险的患者而制定的.
- 评估出血风险对于TAVI后的患者管理至关重要.
研究的目的:
- 为了验证VARC-HBR标准在预测TAVI患者出血风险.
- 将VARC-HBR标准的性能与其他现有风险分层工具进行比较.
- 根据VARC-HBR分类来评估出血事件的逐步增加.
主要方法:
- 分析了POPular PAUSE TAVI随机临床试验中的数据.
- 在基线确定主要和轻微出血风险标准.
- 根据VARC-HBR标准将856名患者分为中度,高和非常高的出血风险组.
- 在TAVI后30天内记录和分析出血事件.
主要成果:
- 在风险组中观察到大出血的逐步增加:4.2% (中等风险),9.5% (高风险) 和15.0% (非常高风险).
- 根据VARC-HBR标准,区分性表现中等,曲线下的面积为0.64.
- 这些标准显示了良好的校准,使观察到的结果与预测的风险保持一致,尽管事件发生率高于预期.
结论:
- 根据VARC-HBR标准,成功地区分了TAVI患者的子组,其中有严重出血风险的升级.
- 虽然对子组识别有效,但VARC-HBR对个体患者风险的预测性能中等.
- 在TAVI患者中,可能需要进一步完善出血风险预测模型.
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