PRECISE-DAPT评分对急性冠状动脉综合征合并糖尿病患者双联抗血小板治疗后出血风险的预测价值

Predictive Value of PRECISE-DAPT Scoring on Bleeding Risk in Patients with Acute Coronary Syndrome and Diabetes Mellitus Treated with Dual Antiplatelet Therapy

目的探讨PRECISE-DAPT评分对接受经皮冠状动脉介入手术(PCI)的急性冠状动脉综合征(ACS)合并糖尿病(DM)患者双联抗血小板(DAPT)治疗后出血风险的预测价值。方法选择ACS合并DM患者200例,PCI术后接受DAPT治疗,随访时间为1年,记录出血事件发生情况,根据是否发生出血事件分为出血组和未出血组,评价PRECISE-DAPT评分对出血事件的预测价值。结果(1)随访期间共有66例(33.00%)发生出血事件,最常见为消化道出血,出血组平均年龄、年龄>65岁比例和治疗前PRECISE-DAPT评分高于未出血组(P<0.05);(2)PRECISEDAPT评分与出血事情呈正相关(r=0.63,P<0.01),出血发生率随着PRECISE-DAPT评分分级增加而升高,其中≥25分组出血发生危险是≤10分组的5.76倍(P<0.05);(3)PRECISE-DAPT评分对于出血风险预测的最佳截断点为16.84,其曲线下面积(AUC)为0.71(Z=5.60,P<0.05,95%CI=0.53~0.85),此时的诊断敏感度为82.27%,特异度为64.09%,阳性预测值为86.27%,阴性预测值为55.73%,准确率为73.37%。结论ACS合并DM患者接受PCI术后出血患者的PRECISE-DAPT评分明显升高,该评分对于出血事件有一定的预测价值。

Objective To investigate the predictive value of PRECISE-DAPT score on bleeding risk in patients with acute coronary syndrome(ACS)and diabetes mellitus(DM)after percutaneous coronary intervention(PCI).Methods 200 patients with ACS and DM were treated with DAPT after PCI,and were followed up for one year.The occurrence of bleeding events was recorded.The patients were divided into bleeding group and non-bleeding group according to the occurrence of bleeding events.The predictive value of PRECISE-DAPT score for bleeding events was evaluated.Results(1)During the follow-up period,66 cases(33.00%)had hemorrhage,the most common was gastrointestinal bleeding.The age,proportion of>65 years old and pre-treatment PRECISE-DAPT score in bleeding group were higher than those in non-bleeding group(P<0.05).(2)PRECISE-DAPT score was positively correlated with bleeding events(r=0.63,P<0.01).The incidence of bleeding increased with the increase of PRECISE-DAPT score.The risk of bleeding in group(≥25)was 5.76 times higher than that in group(<10)(P<0.05).(3)The best cut-off point of PRECISE-DAPT score for hemorrhage risk prediction was 16.84.The area under curve(AUC)was 0.714(Z=5.60,P<0.05,95%CI=0.53~0.85).The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 82.27%,64.09%,86.27%,55.73%and73.37%,respectively.Conclusions The PRECISE-DAPT score of patients with ACS and DM undergoing PCI bleeding was significantly increased,which had certain predictive value for bleeding events.