Objective:To investigate the value of PRECISE-DAPT and CRUSADE scoring system in predicting the in-hospital hemorrhage risk in patients with ACS after PCI. Methods:It was a retrospective analysis of 417 patients with ACS underwent PCI in our hospital from January 2015 to February 2016 (234 cases of ST-segment elevation myocardial infarction,173 cases of non-ST-segment elevation myocardial infarction,10 cases of unstable angina),who were divided into bleeding group for 98 cases and non-bleeding group for 319 cases according to the BARC hemorrhagic type.The PRECISE-DAPT and CRUSADE scores were calculated.The logistic regression analysis and ROC curve were used to analyze the predictive value of the two bleeding risk scores on the bleeding events. Results:The age, proportion of elderly over 65 years old,and the base line PRECISE-DAPT and CRUSADE on admission in bleeding group were significantly higher than those in non-bleeding group (P<0.05).The logistic regression analysis showed that the PRECISE-DAPT score (OR=1.061,95％CI:1.04～1.084,P<0.001)and CRUSADE score (OR= 1.041,95％CI:1.026～ 1.056,P <0.001)were significantly correlated with bleeding events.All the patients were divided into 4 groups according to the scores of PRECISE-DAPT:group A (≤10)107 cases;group B (11～17)130 cases;group C (18～24)79 cases;group D (≥25)101 cases.Logistic regression analysis showed that the risk of hemorrhage in group D was 5.582 times higher than that in group A (P <0.001).The patients were divided into 5 groups according to the scores of CRUSADE:group A (≤20)185 cases;group B (21～30)107 cases;group C (31～40)57 cases;group D (41～50)33 cases;group E (≥51)35 cases.Logistic regression analysis showed that the risk of hemorrhage in group E was 7.262 times higher than that in group A,and the risk of bleeding increased along with the score group by group (E>D>C>B>A).ROC curve analysis showed that the area under the curve (AUC)of PRECISE-DAPT was 0.674 (95％CI:0.611～0.737) and the AUC of CRUSADE was 0.677 (95％CI:0.616～0.737).The AUC of PRECISE-DAPT≥25 was 0.635 (95％CI:0.569 ～ 0.702),and the AUC of CRUSADE≥41 was 0.587 (95％CI:0.519～0.655). Conclusions:Both PRECISE-DAPT and CRUSADE scoring system are valuable on the assessment of in-hospital hemorrhage in patients with ACS after PCI,but the PRECISE-DAPT scoring system is better only in patients with higher score.%目的:比较PRECISE-DAPT、CRUSADE评分系统对急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后近期出血风险的预测价值.方法:回顾性分析2015年1月至2016年2月因ACS行PCI的患者共417例,其中ST段抬高型心肌梗死234例、非ST段抬高型心肌梗死173例、不稳定心绞痛10例.根据有无出血事件将患者分为出血组(n=98)和未出血组(n=319).记录患者PRECISE-DAPT、CRUSADE出血评分,logistic回归分析两种出血评分与出血的相关性;受试者工作特征(ROC)曲线分析两种出血评分对出血事件预测的准确性.结果:出血组患者的年龄、>65岁老年人的比例、入院时基线PRECISE-DAPT评分和CRUSADE评分均显著高于未出血组(P均<0.05).logistic回归分析显示PRECISE-DAPT评分、CRUSADE评分均与出血事件密切相关(PRECISE-DAPT评分OR=1.061,95％CI:1.04～1.084,P<0.001;CRUSADE评分OR=1.041,95％CI:1.026～1.056,P<0.001).根据PRECISE-DAPT评分将患者分成4组:A组(≤10分)107例;B组(11～17分)130例;C组(18～24分)79例;D组(≥25分)101例.Logistic回归分析显示D组发生出血的风险是A组的5.582倍.根据CRUSADE评分将患者分成5组:A组(≤20分)185例;B组(21～30分)107例;C组(31～40分)57例;D组(41～50分)33例,E组(≥51分)35例.Logistic回归分析显示随着CRUSADE评分增高,出血风险增加(E组>D组>C组>B组>A组),E组出血风险是A组的7.262倍.ROC曲线分析显示,PRECISE-DAPT评分的曲线下面积为0.674(95％CI:0.611～0.737),CRUSADE评分的曲线下面积为0.677(95％CI:0.616～0.737),其中PRECISE-DAPT评分≥25分的曲线下面积为0.635(95％CI:0.569～0.702),CRUSADE评分≥41分的曲线下面积为0.587(95％CI:0.519～0.655).结论:PRECISE-DAPT、CRUSADE出血评分对ACS患者近期出血均有良好的预测价值,其中CRUSADE评分对于院内出血事件的预测作用较好,而PRECISE-DAPT评分的预测作用存在局限性,仅在评分较高的患者中有较好的预测作用.
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