PRECISE-DAPT评分与CRUSADE评分对老年急性冠脉综合征患者经皮冠状动脉介入术后出血事件预测价值比较

Comparison of the predictive value of PRECISE-DAPT score and CRUSADE score in elderly patients with acute coronary syndrome after percutaneous coronary intervention

目的比较PRECISE-DAPT评分与CRUSADE评分对老年急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后1年内发生出血事件的预测价值。方法选择2018年1月~2019年6月就诊于石河子大学医学院第一附属医院诊断为ACS并行PCI、年龄>65岁的167例患者为研究对象,对患者随访1年,失访4例,死亡3例,1年内发生出血的36例患者为出血组,1年内未发生出血的124例患者为未出血组。计算患者的PRECISE-DAPT评分与CRUSADE评分,比较PRECISE-DAPT评分与CRUSADE评分对老年ACS患者PCI术后1年内出血事件的预测价值。结果两组患者饮酒史、既往自发性出血史、消化系统疾病史、心率、入院时PRECISE-DAPT评分与CRUSADE评分差异均有统计学意义(P<0.05)。Logistic回归分析显示:PRECISE-DAPT评分[OR=1.077,95%CI(1.035,1.121),P=0.000],CRUSADE评分[OR=1.063,95%CI(1.029,1.098),P=0.000]均与出血事件相关。ROC曲线分析显示:PRECISE-DAPT评分曲线下面积为0.668,95%CI(0.589,0.740),CRUSADE评分曲线下面积为0.707,95%CI(0.630,0.776),两种评分系统对老年ACS患者PCI术后1年内出血事件的预测价值差异无统计学意义(Z=0.727,P=0.467)。结论 PRECISE-DAPT评分与CRUSADE评分对老年ACS患者PCI术后1年内出血事件均有预测价值,且预测价值相当。

Objective To compare the predictive value of PRECISE-DAPT score and CRUSADE score for bleeding within one year after percutaneous coronary intervention(PCI)in elderly patients with acute coronary syndrome(ACS).Methods One hundred and sixty-seven patients with ACS undergoing PCI,aged over 65 years,in the First Affiliated Hospital of Shihezi University School of Medicine from Jan 2018 to Jun 2019 were enrolled as the research objects.The patients were followed up for one year,4 cases were lost to follow-up and 3 cases died.Thirty-six patients with bleeding events within one year were enrolled as the bleeding group,one hundred and twenty-four patients without bleeding within one year were enrolled as non-bleeding group.The PRECISE-DAPT score and CRUSADE score were calculated,compared the predictive value of PRECISE-DAPT score and CRUSADE score on bleeding events within one year after PCI in elderly patients with ACS.Results There were statistically significant differences in drinking history,spontaneous bleeding history,digestive system diseases history,heart rate,PRECISE-DAPT score and CRUSADE score between the two groups(P<0.05).Logistic regression analysis showed that PRECISE-DAPT score[OR=1.077,95%CI(1.035,1.121),P=0.000]and CRUSADE score[OR=1.063,95%CI(1.029,1.098),P=0.000]were associated with bleeding events.ROC curve analysis showed that the area under curve of PRECISE-DAPT score was 0.668[95%CI(0.589,0.740)],and the area under curve of CRUSADE score was 0.707[95%CI(0.630,0.776)].There was no statistically significant difference between the two scoring systems in predicting bleeding events within one year after PCI in elderly ACS patients(Z=0.727,P=0.467).Conclusion Both PRECISE-DAPT score and CRUSADE score have predictive value for bleeding events within one year after PCI in elderly patients with ACS,and the predicitive value is similar.