ARC-HBR和precision - dapt冠状动脉支架植入术后高危出血定义的不一致和表现。

IF 11.7 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular interventions Pub Date : 2025-03-10 DOI:10.1016/j.jcin.2024.10.032

Carl-Emil Lim MD , Moa Simonsson MD, PhD , Björn Pasternak MD, PhD , Tomas Jernberg MD, PhD , Gustaf Edgren MD, PhD , Peter Ueda MD, PhD

{"title":"ARC-HBR和precision - dapt冠状动脉支架植入术后高危出血定义的不一致和表现。","authors":"Carl-Emil Lim MD , Moa Simonsson MD, PhD , Björn Pasternak MD, PhD , Tomas Jernberg MD, PhD , Gustaf Edgren MD, PhD , Peter Ueda MD, PhD","doi":"10.1016/j.jcin.2024.10.032","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The aim of the ARC-HBR (Academic Research Consortium for High Bleeding Risk) and PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score definitions for high bleeding risk is to identify patients who would benefit from shorter or less intensive antiplatelet therapy after coronary stenting.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the performance of the ARC-HBR and PRECISE-DAPT score definitions for high bleeding risk in routine clinical practice.</div></div><div><h3>Methods</h3><div>Using nationwide registers, all patients in Stockholm, Sweden, who were discharged after coronary stenting with dual antiplatelet therapy (January 1, 2013, to July 1, 2018) were included. Patients were categorized as high bleeding risk according to the 2 risk tools, and risk for bleeding (BARC [Bleeding Academic Research Consortium] types 3-5 or TIMI major or minor) and ischemic events (myocardial infarction or ischemic stroke) within 1 year after discharge was assessed.</div></div><div><h3>Results</h3><div>Of 7,562 patients, the proportions categorized as high bleeding risk were 27% (2,004 of 7,562) using the ARC-HBR definition and 38% (2,894 of 7,562) using the PRECISE-DAPT score; 22% (1,696 of 7,562) had discordant categorization of high bleeding risk comparing the 2 risk tools. Patients with vs without high bleeding risk according to the ARC-HBR definition had higher risk for BARC type 3 to 5 bleeding (1-year risk 7.1% vs 2.3%; HR: 3.21; 95% CI: 2.47-4.17) and ischemic events (7.8% vs 2.8%; HR: 2.96; 95% CI: 2.31-3.79). Patients with vs without high bleeding risk according to the PRECISE-DAPT score had higher risk for TIMI major or minor bleeding (4.4% vs 2.1%; HR: 2.17; 95% CI: 1.63-2.89) and ischemic events (6.2% vs 2.7%; HR: 2.38; 95% CI: 1.85-3.05). The PRECISE-DAPT score underestimated bleeding risk across almost all score levels (median absolute difference between observed and predicted 1-year risk 1.1%; Q1-Q3: 0.8%-1.4%).</div></div><div><h3>Conclusions</h3><div>There was substantial discordance in the categorization of high bleeding risk between the ARC-HBR definition and the PRECISE-DAPT score. Both tools identified patients at increased bleeding risk, but those patients also had increased ischemic risk. The PRECISE-DAPT score underestimated bleeding risk. Guideline-recommended high bleeding risk definitions may not be generalizable across patient populations, and refined scoring systems are needed.</div></div>","PeriodicalId":14688,"journal":{"name":"JACC. Cardiovascular interventions","volume":"18 5","pages":"Pages 637-650"},"PeriodicalIF":11.7000,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Discordance and Performance of the ARC-HBR and PRECISE-DAPT High Bleeding Risk Definitions After Coronary Stenting\",\"authors\":\"Carl-Emil Lim MD , Moa Simonsson MD, PhD , Björn Pasternak MD, PhD , Tomas Jernberg MD, PhD , Gustaf Edgren MD, PhD , Peter Ueda MD, PhD\",\"doi\":\"10.1016/j.jcin.2024.10.032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The aim of the ARC-HBR (Academic Research Consortium for High Bleeding Risk) and PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score definitions for high bleeding risk is to identify patients who would benefit from shorter or less intensive antiplatelet therapy after coronary stenting.</div></div><div><h3>Objectives</h3><div>The aim of this study was to assess the performance of the ARC-HBR and PRECISE-DAPT score definitions for high bleeding risk in routine clinical practice.</div></div><div><h3>Methods</h3><div>Using nationwide registers, all patients in Stockholm, Sweden, who were discharged after coronary stenting with dual antiplatelet therapy (January 1, 2013, to July 1, 2018) were included. Patients were categorized as high bleeding risk according to the 2 risk tools, and risk for bleeding (BARC [Bleeding Academic Research Consortium] types 3-5 or TIMI major or minor) and ischemic events (myocardial infarction or ischemic stroke) within 1 year after discharge was assessed.</div></div><div><h3>Results</h3><div>Of 7,562 patients, the proportions categorized as high bleeding risk were 27% (2,004 of 7,562) using the ARC-HBR definition and 38% (2,894 of 7,562) using the PRECISE-DAPT score; 22% (1,696 of 7,562) had discordant categorization of high bleeding risk comparing the 2 risk tools. Patients with vs without high bleeding risk according to the ARC-HBR definition had higher risk for BARC type 3 to 5 bleeding (1-year risk 7.1% vs 2.3%; HR: 3.21; 95% CI: 2.47-4.17) and ischemic events (7.8% vs 2.8%; HR: 2.96; 95% CI: 2.31-3.79). Patients with vs without high bleeding risk according to the PRECISE-DAPT score had higher risk for TIMI major or minor bleeding (4.4% vs 2.1%; HR: 2.17; 95% CI: 1.63-2.89) and ischemic events (6.2% vs 2.7%; HR: 2.38; 95% CI: 1.85-3.05). The PRECISE-DAPT score underestimated bleeding risk across almost all score levels (median absolute difference between observed and predicted 1-year risk 1.1%; Q1-Q3: 0.8%-1.4%).</div></div><div><h3>Conclusions</h3><div>There was substantial discordance in the categorization of high bleeding risk between the ARC-HBR definition and the PRECISE-DAPT score. Both tools identified patients at increased bleeding risk, but those patients also had increased ischemic risk. The PRECISE-DAPT score underestimated bleeding risk. Guideline-recommended high bleeding risk definitions may not be generalizable across patient populations, and refined scoring systems are needed.</div></div>\",\"PeriodicalId\":14688,\"journal\":{\"name\":\"JACC. Cardiovascular interventions\",\"volume\":\"18 5\",\"pages\":\"Pages 637-650\"},\"PeriodicalIF\":11.7000,\"publicationDate\":\"2025-03-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Cardiovascular interventions\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1936879824014687\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular interventions","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936879824014687","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

摘要

背景：ARC-HBR（高出血风险学术研究联盟）和precision - dapt（预测接受支架植入和随后双重抗血小板治疗的患者的出血并发症）评分定义的目的是确定冠状动脉支架植入术后短期或较低强度抗血小板治疗的患者。目的：本研究的目的是评估ARC-HBR和precision - dapt评分定义在常规临床实践中高出血风险的表现。方法：采用全国登记资料，纳入2013年1月1日至2018年7月1日在瑞典斯德哥尔摩接受双重抗血小板治疗的冠状动脉支架植入术后出院的所有患者。根据2种风险工具将患者划分为高出血风险，并评估出院后1年内出血（BARC [bleeding Academic Research Consortium] 3-5型或TIMI主要或次要）和缺血性事件（心肌梗死或缺血性卒中）的风险。结果：在7562例患者中，使用ARC-HBR定义归为高出血风险的比例为27%（7562例中的2004例），使用precision - dapt评分归为38%（7562例中的2894例）；22%（7,562人中1,696人）的高出血风险分类与两种风险工具相比不一致。根据ARC-HBR定义，有高出血风险的患者与无高出血风险的患者发生BARC 3 - 5型出血的风险更高(1年风险7.1% vs 2.3%；人力资源:3.21;95% CI: 2.47-4.17)和缺血事件(7.8% vs 2.8%；人力资源:2.96;95% ci: 2.31-3.79)。根据precision - dapt评分，有高出血风险的患者与没有高出血风险的患者发生TIMI大出血或小出血的风险更高(4.4%对2.1%；人力资源:2.17;95% CI: 1.63-2.89)和缺血事件(6.2% vs 2.7%；人力资源:2.38;95% ci: 1.85-3.05)。precision - dapt评分在几乎所有评分水平上都低估了出血风险(1年观察风险和预测风险的绝对中位数差为1.1%；Q1-Q3: 0.8% - -1.4%)。结论：ARC-HBR定义与precision - dapt评分在高出血风险分类上存在显著不一致。这两种工具都能识别出出血风险增加的患者，但这些患者也有缺血性风险增加。precision - dapt评分低估了出血风险。指南推荐的高出血风险定义可能无法在患者群体中推广，需要完善的评分系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Discordance and Performance of the ARC-HBR and PRECISE-DAPT High Bleeding Risk Definitions After Coronary Stenting

Background

The aim of the ARC-HBR (Academic Research Consortium for High Bleeding Risk) and PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy) score definitions for high bleeding risk is to identify patients who would benefit from shorter or less intensive antiplatelet therapy after coronary stenting.

Objectives

The aim of this study was to assess the performance of the ARC-HBR and PRECISE-DAPT score definitions for high bleeding risk in routine clinical practice.

Methods

Using nationwide registers, all patients in Stockholm, Sweden, who were discharged after coronary stenting with dual antiplatelet therapy (January 1, 2013, to July 1, 2018) were included. Patients were categorized as high bleeding risk according to the 2 risk tools, and risk for bleeding (BARC [Bleeding Academic Research Consortium] types 3-5 or TIMI major or minor) and ischemic events (myocardial infarction or ischemic stroke) within 1 year after discharge was assessed.

Results

Of 7,562 patients, the proportions categorized as high bleeding risk were 27% (2,004 of 7,562) using the ARC-HBR definition and 38% (2,894 of 7,562) using the PRECISE-DAPT score; 22% (1,696 of 7,562) had discordant categorization of high bleeding risk comparing the 2 risk tools. Patients with vs without high bleeding risk according to the ARC-HBR definition had higher risk for BARC type 3 to 5 bleeding (1-year risk 7.1% vs 2.3%; HR: 3.21; 95% CI: 2.47-4.17) and ischemic events (7.8% vs 2.8%; HR: 2.96; 95% CI: 2.31-3.79). Patients with vs without high bleeding risk according to the PRECISE-DAPT score had higher risk for TIMI major or minor bleeding (4.4% vs 2.1%; HR: 2.17; 95% CI: 1.63-2.89) and ischemic events (6.2% vs 2.7%; HR: 2.38; 95% CI: 1.85-3.05). The PRECISE-DAPT score underestimated bleeding risk across almost all score levels (median absolute difference between observed and predicted 1-year risk 1.1%; Q1-Q3: 0.8%-1.4%).

Conclusions

There was substantial discordance in the categorization of high bleeding risk between the ARC-HBR definition and the PRECISE-DAPT score. Both tools identified patients at increased bleeding risk, but those patients also had increased ischemic risk. The PRECISE-DAPT score underestimated bleeding risk. Guideline-recommended high bleeding risk definitions may not be generalizable across patient populations, and refined scoring systems are needed.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

JACC. Cardiovascular interventions CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

11.60

自引率

8.80%

发文量

756

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Interventions is a specialist journal launched by the Journal of the American College of Cardiology (JACC). It covers the entire field of interventional cardiovascular medicine, including cardiac, peripheral, and cerebrovascular interventions. The journal publishes studies that will impact the practice of interventional cardiovascular medicine, including clinical trials, experimental studies, and in-depth discussions by respected experts. To enhance visual understanding, the journal is published both in print and electronically, utilizing the latest technologies.