Prediction of Thrombotic and Bleeding Events After Percutaneous Coronary Intervention: CREDO‐Kyoto Thrombotic and Bleeding Risk Scores

Journal of the American Heart Association - Tập 7 Số 11 - 2018
Masahiro Natsuaki1, Takeshi Morimoto2, Kyohei Yamaji3, Hirotoshi Watanabe4, Yusuke Yoshikawa4, Hiroki Shiomi4, Yoshihisa Nakagawa5, Yutaka Furukawa6, Kazushige Kadota7, Kenji Andò3, Takashi Akasaka8, Keiichi Igarashi Hanaoka9, Ken Kozuma10, Yu Sato11, Yoshihiro Morino12, Toshiya Muramatsu13, Takeshi Kimura4
1Department of Cardiovascular Medicine, Saga University, Saga, Japan
2Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
3Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
4Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
5Division of Cardiology, Tenri Hospital, Tenri, Japan
6Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
7Division of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
8Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
9Division of Cardiology, Hanaokaseishu Memorial Cardiovascular Clinic, Sapporo, Japan
10Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
11Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
12Division of Cardiology, Iwate Medical University Hospital, Morioka, Japan
13Division of Cardiology, Tokyo Hospital, Tokyo, Japan

Tóm tắt

Background Prediction of thrombotic and bleeding risk is important to optimize antithrombotic therapy after percutaneous coronary intervention.

Methods and Results We developed the prediction rules for thrombotic and bleeding events separately in Japanese patients. Derivation and validation cohorts consisted of 4778 patients from CREDO ‐Kyoto (Coronary Revascularization Demonstrating Outcome Study in Kyoto) registry cohort 2 and 4669 patients from RESET (Randomized Evaluation of Sirolimus‐Eluting Versus Everolimus‐Eluting Stent Trial) and NEXT (Nobori Biolimus‐Eluting Versus Xience/Promus Everolimus‐Eluting Stent Trial). Primary thrombotic and bleeding events were a composite of myocardial infarction, definite or probable stent thrombosis or ischemic stroke, and GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) moderate or severe bleeding. The prediction rule for thrombosis assigned 2 points for severe chronic kidney disease, atrial fibrillation, peripheral vascular disease, and anemia and 1 point for age ≥75 years, heart failure, diabetes mellitus, and chronic total occlusion. The prediction rule for bleeding assigned 2 points for thrombocytopenia, severe chronic kidney disease, peripheral vascular disease, and heart failure and 1 point for prior myocardial infarction, malignancy, and atrial fibrillation. In derivation and validation cohorts, area under the curve was 0.68 and 0.64, respectively, for thrombosis and 0.66 and 0.66, respectively, for bleeding. In the validation cohort, a high thrombosis risk score (≥4, n=682) was associated with higher 3‐year incidence of thrombotic events than a score that was intermediate (2–3, n=1178) or low (0–1, n=2809) (7.6%, 3.7%, versus 2.4%, respectively; P <0.0001). A high bleeding risk score (≥3, n=666) was associated with higher incidence of bleeding than scores that were intermediate (1–2, n=1802) or low (0, n=2201) (8.8%, 4.1%, versus 2.3%, respectively; P <0.0001). Among 682 patients at high thrombotic risk, only 39 (5.7%) had low bleeding risk, whereas 401 (58.8%) had high bleeding risk with very high incidence of bleeding (11.6%).

Conclusions CREDO ‐Kyoto thrombotic and bleeding risk scores demonstrated modest accuracy in stratifying thrombotic and bleeding risks; however, a large proportion of patients at high thrombotic risk also had high bleeding risk.

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Journal of the American Heart Association

Tập 7 Số 11

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