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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 12  |  Page : 1406-1411

Evaluation of the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients Bleeding Score for Predicting the Long-term Out-of-hospital Bleeding Risk in Chinese Patients after Percutaneous Coronary Intervention


1 Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
2 Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

Correspondence Address:
Dr. Jin-Qing Yuan
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.228766

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Background: The Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients (PARIS) bleeding score is a novel score for predicting the out-of-hospital bleeding risk after percutaneous coronary intervention (PCI). However, whether this score has the same value in non-European and American populations is unclear. This study aimed to assess the PARIS bleeding score's predictive value of bleeding in patients after PCI in the Chinese population. Methods: We performed a prospective, observational study of 10,724 patients who underwent PCI from January to December 2013, in Fuwai Hospital, China. We defined the primary end point as major bleeding (MB) according to Bleeding Academic Research Consortium definition criteria including Type 2, 3, or 5. The predictive value of the PARIS bleeding score was assessed with the area under the receiver operating characteristic (AUROC) curve. Results: Of 9782 patients, 245 (2.50%) MB events occurred during the 2 years of follow-up. The PARIS bleeding score was significantly higher in the MB group than that of non-MB group (4.00 [3.00, 5.00] vs. 3.00 [2.00, 5.00], Z = 3.71, P < 0.001). According to risk stratification of the PARIS bleeding score, the bleeding risk in the intermediate- and high-risk groups was 1.50 times (hazard ratio [HR]: 1.50; 95% confidence interval [CI]: 1.160–1.950; P = 0.002) and 2.27 times higher (HR: 2.27; 95% CI: 1.320–3.900; P = 0.003) than that in the low-risk group. The PARIS bleeding score showed a moderate predictive value for MB in the overall population (AUROC: 0.568, 95% CI: 0.532–0.605; P < 0.001) and acute coronary syndrome (ACS) subgroup (AUROC: 0.578, 95% CI: 0.530–0.626; P = 0.001) and tended to be predictive in the non-ACS subgroup (AUROC: 0.556, 95% CI: 0.501–0.611; P = 0.054). Conclusion: The PARIS bleeding score shows good clinical value for risk stratification and has a significant, but relatively limited, prognostic value for out-of-hospital bleeding in the Chinese population after PCI.

 

 Abstract in Chinese

评估PARIS出血评分对中国经皮冠状动脉介入患者 长期院外出血风险的预测价值

摘要

背景: 支架术后抗血小板药物停药模式(Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients,PARIS)的出血评分为评估经皮冠状动脉介入(percutaneous coronary intervention,PCI)患者院外出血风险的新型评分。但该评分是否对非欧美人群具有同样价值尚不清楚。本研究目的为评估PARIS评分对中国PCI人群出血的预测价值。

方法: 本研究为前瞻、观察性研究,纳入10724例从2013年1月到12月在阜外医院行PCI治疗的患者。主要出血事件的定义为出血学术研究协会定义(Bleeding Academic Research Consortium Definition,BARC)的2,3或5型的出血。使用受试者操作特征的曲线下面积(Area under the receiver operating characteristics curve,AUROC)评估PARIS出血评分的预测价值。

结果: 9872例患者经2年随访,共发生245(2.5%)例主要出血事件。PARIS出血评分在出血事件组明显高于非出血事件组(4.00 [3.00, 5.00] vs. 3.00 [2.00, 5.00], Z=3.71, P<0.001)。按照PARIS评分的危险分层,中危组的出血风险是低危组的1.5倍(风险比[HR]:1.50; 95% 可信区间 [CI]:1.160-1.950;P=0.002);高危组的出血风险是低危组的2.27倍(HR: 2.27; 95%CI: 1.320-3.900;P=0.003)。PARIS出血评分对总人群(AUROC: 0.568, 95%CI:0.532-0.605; P<0.001)和急性冠脉综合征(Acute coronary syndrome,ACS)亚组患者有预测价值(AUROC:0.578, 95% CI:0.530-0.626; P=0.001);对非ACS亚组的患者显示有统计学趋势(AUROC:0.556, 95% CI:0.501-0.611;P=0.054)。

结论: 对于行PCI的中国人群,PARIS出血评分显示对院外出血有较好的危险分层的临床价值,并且显示出有统计学意义,但出血预测价值相对有限。



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