CRUSADE评分与HAS-BLED评分评估非ST段抬高型急性冠脉综合征患者双重抗血小板治疗后出血风险的价值比较

CRUSADE scores and HAS-BLED scores for reviewing bleeding risk after dual antiplatelet treatment in patients with non-ST-segment elevation acute coronary syndromes: a comparison in value

目的比较CRUSADE评分与HAS-BLED评分评估非ST段抬高型急性冠脉综合征(NSTEACS)患者双重抗血小板治疗后出血风险的价值。方法回顾性分析清华大学第一附属医院自2014年2月~2018年2月间治疗的671例NSTE-ACS患者的临床资料,均实施双重抗血小板治疗并行CRUSADE评分及HAS-BLED评分,观察患者短期和远期主要出血事件发生情况,比较不同CRUSADE、HAS-BLED危险分级的短期和远期主要出血事件发生率,分析CRUSADE评分和HAS-BLED评分预测主要出血事件发生的效能。结果 671例患者中院内短期主要出血事件发生率1.49%;随访12个月,随访率93.59%,随访远期主要出血事件发生率8.92%;不同CRUSADE、HAS-BLED危险分级的院内短期和随访远期主要出血事件发生率比较,差异均有统计学意义(P<0.05);CRUSADE评分与HAS-BLED评分预测院内短期主要出血事件发生的ROC曲线AUC比较,差异无统计学意义(P>0.05);预测随访远期主要出血事件发生的ROC曲线AUC比较,差异有统计学意义(P<0.05)。结论在接受双重抗血小板治疗的NSTE-ACS患者中,CRUSADE评分与HAS-BLED评分评估院内短期出血风险的价值相当,CRUSADE评分在评估随访远期出血风险方面较HAS-BLED评分有显著优势。

Objective To compare the value of CRUSADE scores and HAS-BLED scores in reviewing bleeding risk after dual antiplatelet treatment in patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS).Methods The clinical materials from 671 NSTE-ACS patients were retrospectively analyzed in the First Affiliated Hospital of Tsinghua University from Feb.2014 to Feb.2018.All patients were given dual antiplatelet treatment,and CRUSADE scoring and HAS-BLED scoring.The occurrence of short-term and longterm major bleeding events was observed,and incidence of short-term and long-term major bleeding events with different CRUSADE and HAS-BLED risk grades was compared.The efficiency of CRUSADE scores and HASBLED scores for predicting major bleeding events was analyzed.Results The incidence of short-term major bleeding events was 1.49%in 671 patients.The follow-up rate was 93.59%during 12 months,and incidence of long-term major bleeding events was 8.92%.The comparison in incidence between short-term and long-term major bleeding events with different CRUSADE and HAS-BLED risk grades showed that difference had statistical significance(P<0.05).The comparison in AUC of ROC between CRUSADE scores and HAS-BLED scores for predicting incidence of short-term major bleeding events showed that difference had no statistical significance(P>0.05).The comparison in AUC of ROC between CRUSADE scores and HAS-BLED scores for predicting incidence of long-term major bleeding events showed that difference had statistical significance(P<0.05).Conclusion The value of CRUSADE scores and HAS-BLED scores for predicting risk of short-term major bleeding events is the same,and CRUSADE scores has significant advantages in reviewing risk of long-term major bleeding events compared with HAS-BLED scores in NSTE-ACS patients treated with dual antiplatelet therapy.