Prediction of Thrombotic and Bleeding Events After Percutaneous Coronary Intervention: CREDO-Kyoto Thrombotic and Bleeding Risk Scores.
Prediction of Thrombotic and Bleeding Events After Percutaneous Coronary Intervention: CREDO-Kyoto Thrombotic and Bleeding Risk Scores.
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DOI：
10.1161/jaha.118.008708
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发表时间：
2018-05-22
影响因子：
5.4
通讯作者：
CREDO‐Kyoto PCI/CABG Registry Cohort 2, RESET, and NEXT trial investigators
中科院分区：
文献类型：
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作者：
Natsuaki M;Morimoto T;Yamaji K;Watanabe H;Yoshikawa Y;Shiomi H;Nakagawa Y;Furukawa Y;Kadota K;Ando K;Akasaka T;Hanaoka KI;Kozuma K;Tanabe K;Morino Y;Muramatsu T;Kimura T;CREDO‐Kyoto PCI/CABG Registry Cohort 2, RESET, and NEXT trial investigators
预测血栓和出血风险对于优化经皮冠状动脉介入治疗后的抗血栓治疗非常重要。我们在日本患者中分别制定了血栓和出血事件的预测规则。衍生和验证队列包括来自CREDO‐Kyoto（京都冠状动脉血运重建结果证明研究）注册队列2的4778名患者，以及来自RESET（西罗莫司洗脱与依维莫司洗脱支架试验的随机评价）和NEXT （Nobori Biolimus洗脱与Xience/Promus依维莫司洗脱支架试验）的4669名患者。原发性血栓和出血事件是心肌梗死，明确或可能的支架血栓形成或缺血性卒中，以及GUSTO（链激酶和组织纤溶酶原激活剂在闭塞冠状动脉中的全球应用）中度或重度出血的组合。血栓形成预测规则对严重慢性肾脏疾病、心房颤动、周围血管疾病和贫血给予2分，对年龄≥75岁、心力衰竭、糖尿病和慢性全闭塞给予1分。出血预测规则对血小板减少、严重慢性肾脏疾病、外周血管疾病和心力衰竭给予2分，对既往心肌梗死、恶性肿瘤和心房颤动给予1分。在推导和验证队列中，血栓形成的曲线下面积分别为0.68和0.64，出血的曲线下面积分别为0.66和0.66。在验证队列中，高血栓形成风险评分（≥4分，n=682）与3年血栓事件发生率相关，高于中评分（2-3分，n=1178）或低评分（0-1分，n=2809）（分别为7.6%、3.7%和2.4%；P<0.0001）。高出血风险评分（≥3分，n=666）与中评分（1-2分，n=1802分）或低评分（0分，n=2201分）的出血发生率相关（分别为8.8%、4.1%和2.3%；P<0.0001）。在682例高血栓形成风险患者中，只有39例（5.7%）具有低出血风险，而401例（58.8%）具有高出血风险和极高出血发生率（11.6%）。CREDO‐Kyoto血栓和出血风险评分在对血栓和出血风险进行分层时显示出适度的准确性；然而，很大一部分高血栓形成风险的患者也有高出血风险。
Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention. We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO‐Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus‐Eluting Versus Everolimus‐Eluting Stent Trial) and NEXT (Nobori Biolimus‐Eluting Versus Xience/Promus Everolimus‐Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3‐year incidence of thrombotic events than a score that was intermediate (2–3, n=1178) or low (0–1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P<0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1–2, n=1802) or low (0, n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P<0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk, whereas 401 (58.8%) had high bleeding risk with very high incidence of bleeding (11.6%). CREDO‐Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.