Abstract

Background

Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS.

Methods

The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell’s and Uno’s C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R²] and likelihood ratio χ²). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death.

Results

All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59–3.68], R² = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased.

Conclusion

The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.

中文翻译：

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PRECISE-DAPT评分对急性冠脉综合征并发心源性休克患者长期死亡率的预测价值

摘要

背景

除了预测急性冠脉综合征( ACS) 患者出血风险的主要临床用途外，PRECISE-DAPT（预测接受支架植入和后续双抗血小板治疗患者的出血并发症）评分也可能有助于预测出现心源性休克 (CS) 的 ACS 患者的长期死亡率，因为一些研究报告了评分与某些心血管疾病或事件之间的关联。 本研究的目的是评估 PRECISE-DAPT 评分在预测伴有 CS 的 ACS患者 ( n = 293)的长期全因死亡率方面的效用。

方法

计算每位在医院存活的患者的 PRECISE-DAPT 评分，并研究其与长期死亡率的关联。中位随访时间为 2.7 年。最终模型的性能是通过测量其判别力（Harrell 和 Uno 的 C指数以及受试者工作特征曲线下的时间相关面积 [AUC]）和预测准确性（确定系数 [ R ² ] 和似然比 χ ）来确定的。²）。风险比（HR）用于评估模型变量与长期全因死亡之间的关系。

结果

197 名患者（67%）发生全因死亡。PRECISE-DAPT 评分（从 17 变为 38 与 HR 2.42 相关 [95% CI：1.59–3.68]，R ²  = 0.209，时间依赖性 AUC = 0.69）与以下风险之间存在正相关：死亡，因此在调整后的生存曲线中，死亡风险随着 PRECISE-DAPT 评分的增加而增加。

结论

PRECISE-DAPT 评分可能是一个有用且易于使用的工具，用于预测 ACS 并发 CS 患者的长期死亡率。