Predictive validation of existing bleeding and thromboembolic scores in elderly patients with comorbid atrial fibrillation and acute coronary syndrome
Hong-Hong ZHANG1
Qi LIU2
Hai-Jing ZHAO1
Ya-Ni YU3
Liu-Yang TIAN1
Ying-Yue ZHANG1
Zi-Hao FU1
Li ZHENG1
Yue ZHU1
Yu-Han MA1
Shuang LI4
Yang-Yang MA4
Yu-Qi LIU5
1.Medical School of Chinese PLA,Beijing,China;Department of Cardiology & National Clinical Research Center of Geriatrics Disease; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine; National Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China2.Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China3.Department of Cardiology & National Clinical Research Center of Geriatrics Disease; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine; National Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China4.Department of Information, Chinese PLA General Hospital, Beijing, China5.Department of Cardiology & National Clinical Research Center of Geriatrics Disease; Beijing Key Laboratory of Chronic Heart Failure Precision Medicine; National Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, China;Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
摘要：BACKGROUND The validation of various risk scores in elderly patients with comorbid atrial fibrillation(AF)and acute coron-ary syndrome(ACS)has not been reported.The present study compared the predictive performance of existing risk scores in these patients.METHODS A total of 1252 elderly patients with AF and ACS comorbidities(≥65 years old)were consecutively enrolled from January 2015 to December 2019.All patients were followed up for one year.The predictive performance of risk scores in predict-ing bleeding and thromboembolic events was calculated and compared.RESULTS During the 1-year follow-up,183(14.6％)patients had thromboembolic events,198(15.8％)patients had BARC class≥2 bleeding events,and 61(4.9％)patients had BARC class≥3 bleeding events.For the BARC class≥3 bleeding events,discrimina-tion of the existing risk scores was low to moderate,PRECISE-DAPT(C-statistic:0.638,95％CI:0.611-0.665),ATRIA(C-statistic:0.615,95％CI:0.587-0.642),PARIS-MB(C-statistic:0.612,95％CI:0.584-0.639),HAS-BLED(C-statistic:0.597,95％CI:0.569-0.624)and CRUSADE(C-statistic:0.595,95％CI:0.567-0.622).However,the calibration was good.PRECISE-DAPT showed a higher in-tegrated discrimination improvement(IDI)than PARIS-MB,HAS-BLED,ATRIA,and CRUSADE(P<0.05)and the best decision curve analysis(DCA).For thromboembolic events,the discrimination of GRACE(C-statistic:0.636,95％CI:0.608-0.662)was higher than CHA2DS2-VASc(C-statistic:0.612,95％CI:0.584-0.639),OPT-CAD(C-statistic:0.602,95％CI:0.574-0.629)and PARIS-CTE(C-statistic:0.595,95％CI:0.567-0.622).The calibration was good.Compared to OPT-CAD and PARIS-CTE,the IDI of the GRACE score slightly improved(P<0.05).However,NRI analysis showed no significant difference.DCA showed that the clinical practic-ability of thromboembolic risk scores was similar.CONCLUSIONS The discrimination and calibration of existing risk scores in predicting 1-year thromboembolic and bleeding events were unsatisfactory in elderly patients with comorbid AF and ACS.PRECISE-DAPT showed higher IDI and DCA than other risk scores in predicting BARC class≥3 bleeding events.The GRACE score showed a slight advantage in predicting throm-botic events.
机标关键词：withacuteatrialbleedingcomorbidcoronaryelderlyexisting
论文发表日期：2023-05-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：11( 330-340 )