Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents Risk Scores From PARIS
Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents Risk Scores From PARIS
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DOI：
10.1016/j.jacc.2016.02.064
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发表时间：
2016-05-17
影响因子：
24
通讯作者：
Pocock, Stuart
中科院分区：
文献类型：
--
作者：
Baber, Usman;Mehran, Roxana;Pocock, Stuart
背景：经皮冠状动脉介入治疗后阿司匹林和氯吡格雷的双重抗血小板治疗降低了冠状动脉血栓事件（cte）的风险，但增加了大出血（MB）的风险。缺乏准确预测每种事件发生并为临床决策提供信息的指标。目的：本研究的目的是建立和验证单独的模型，以预测经皮冠状动脉药物洗脱支架介入治疗后院外血栓形成和出血事件的风险。方法使用来自4190名接受药物洗脱支架治疗的患者的数据，并纳入PARIS（支架患者抗血小板方案不依从模式）登记，制定单独的风险评分来预测CTE（定义为支架血栓形成或心肌梗死的复合）和MB（定义为出血的学术研究联盟3型或5型出血的发生）。外部验证在ADAPT-DES（药物洗脱支架双重抗血小板治疗评估）注册中进行。结果2年多来，CTEs发生151例（3.8%），MB发生133例（3.3%）。CTEs的独立预测因子包括急性冠状动脉综合征、既往血运重建术、糖尿病、肾功能障碍和当前吸烟。MB的独立预测因素包括年龄较大、体重指数、出院时三联治疗、贫血、当前吸烟和肾功能不全。每个模型显示中等水平的辨别和适当的校准。结论基线临床变量的简单风险评分可能有助于预测PCI合并DES后缺血性和出血事件的风险，从而有助于围绕DAPT最佳持续时间的临床决策。支架患者抗血小板方案不依从性的模式[PARIS]； NCT00998127) (C) 2016由美国心脏病学会基金会发布。
BACKGROUND Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking.OBJECTIVES The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after percutaneous coronary intervention with drug-eluting stents.METHODS Using data from 4,190 patients treated with drug-eluting stents and enrolled in the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients) registry, separate risk scores were developed to predict CTE (defined as the composite of stent thrombosis or myocardial infarction) and MB (defined as the occurrence of a Bleeding Academic Research Consortium type 3 or 5 bleed). External validation was performed in the ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) registry.RESULTS Over 2 years, CTEs occurred in 151 patients (3.8%) and MB in 133 (3.3%). Independent predictors of CTEs included acute coronary syndrome, prior revascularization, diabetes mellitus, renal dysfunction, and current smoking. Independent predictors of MB included older age, body mass index, triple therapy at discharge, anemia, current smoking, and renal dysfunction. Each model displayed moderate levels of discrimination and adequate calibration.CONCLUSIONS Simple risk scores of baseline clinical variables may be useful to predict risks for ischemic and bleeding events after PCI with DES, thereby facilitating clinical decisions surrounding the optimal duration of DAPT. (Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients [PARIS]; NCT00998127) (C) 2016 by the American College of Cardiology Foundation.