PARIS出血评分对急性心肌梗死药物支架术后患者院内出血的预测价值--中国急性心肌梗死注册研究

Predictive Value of PARIS Bleeding Score on In-hospital Bleeding of Acute Myocardial Infarction Patients With Drug-eluting Stent Implantation

目的:评估支架术后抗血小板药物停药模式(PARIS)出血评分对我国使用药物洗脱支架(DES)并应用双联抗血小板治疗(DAPT)的急性心肌梗死(AMI)患者住院期间出血的预测价值。方法:中国急性心肌梗死(CAMI)注册研究在2013-01-01至2014-09-30期间107家医院连续入选了27 594例AMI患者,其中14 625例在住院期间成功置入DES并接受DAPT,分别采用出血学术研究联合会(BARC)3型和5型及BARC 2型、3型和5型做为出血的终点事件,评价我国置入DES术后接受DAPT的AMI患者住院期间出血发生情况、临床特征和PARIS出血评分对这两种出血终点事件的预测价值。结果:出血患者的PARIS评分明显高于无出血患者(P<0.001)。按照PARIS评分的危险分层,以BARC 3型和5型为出血终点时,共有77例(0.53%)患者出现出血事件,高危、中危、低危患者之间的PARIS评分差异有统计学意义(P<0.001)。出血中危患者出血风险是低危患者的2.38倍(P=0.006);出血高危患者出血风险是低危患者的4.78倍(P<0.001)。以BARC 2型、3型和5型为出血终点,共有223例(1.52%)出现出血事件。出血中危患者出血风险是低危患者的1.64倍(P=0.002);出血高危患者出血风险是低危患者的2.23倍(P=0.001)。受试者工作特征(ROC)曲线分析显示,PARIS出血评分对以BARC 3型和5型或BARC 2型、3型和5型为出血事件终点均有预测价值。对以BARC 3型和5型为终点的预测价值[曲线下面积(AUC):0.672]高于以BARC 2型、3型和5型为出血事件终点的预测价值(AUC:0.596;z=2.079,P=0.038),即PARIS出血评分对严重出血的预测价值更优。结论:PARIS出血评分对置入DES并接受DAPT的AMI患者住院期间出血具有预测价值,并可用于危险分层。PARIS出血评分对严重出血作为终点事件的预测价值更优。

Objective： To evaluate the predictive value of PARIS bleeding score on in-hospital bleeding of acute myocardial infarction（AMI） patients after drug-eluting stent（DES） implantation with dual-antiplatelet therapy（DAPT）.Methods： There were 27 594 AMI patients enrolled in China acute myocardial infarction（CAMI） registry between 2013-01-01 to 2014-09-30 from 107 hospitals, and 14 625 of them had successful in-hospital DES implantation with DAPT werestudied. Based on BARC（bleeding academic research consortium definition） criteria, the end point major bleeding（MB） events were defined by both BARC type 3, 5 and BARC type 2, 3, 5; the incidence of in-hospital bleeding, clinical features and predictive value of PARIS bleeding score according to different BARC type were evaluated.Results： Compared with non-MB patients, MB patients had the higher PARIS bleeding score, P0.001. Based on PARIS score risk stratification, taking BARC type 3, 5 as endpoint, 77/14 625（0.53%） patients had bleeding events, PARIS scores were different among high risk, mid risk and low risk patients, P0.001; bleeding risk in mid risk patients was 2.38 times higher than low risk patients, P=0.006 and bleeding risk in high risk patients was 4.78 times higher than low risk patients, P0.001. Taking BARC type 2, 3, 5 as endpoint, 223（1.52%） patients had bleeding events, bleeding risk in mid risk patients was 1.64 times higher than low risk patients, P=0.002 and bleeding risk in high risk patients was 2.23 times higher than low risk patients, P=0.001. ROC analysis showed that PARIS score had predictive value on both BARC type 3, 5 and BARC type 2, 3, 5 bleeding, area under curve（AUC） of BARC type 3, 5（AUC： 0.672） was higher than AUC of BARC type 2, 3, 5（AUC： 0.596）（z=2.079, P=0.038）, which implied that PARIS score had better predictive value in severe bleeding events.Conclusion： PARIS bleeding score had predictive value on in-hospital bleeding in AMI patients after DES implantation with DAPT, it can also be used in bleeding risk stratification. PARIS bleeding score had better predictive value on severe bleeding.