Predictive Value Of PRECISE-DAPT Score For Gastrointestinal Bleeding In ACS Patients After PCI

Objective: To analyze the predictive value of PRECISE-DAPT score for gastrointestinal bleeding after PCI in ACS patients.Method: Patients diagnosed with ACS and treated with PCI in our hospital from October 2018 to October2019 were selected.All patients were followed up for 1 year by outpatient or telephone.58 Patients with gastrointestinal bleeding within 1 year after PCI were selected as case group,and 232 patients without gastrointestinal bleeding within 1 year after PCI were selected as control group according to the ratio of1:4.Collect clinical data of patients and analyze comprehensively.SPSS 23.0 software was used for statistical analysis,test standard: P<0.05.Results:(1)There were statistically significant differences between the case group and the control group in age,history of digestive system disease,history of chronic renal insufficiency,history of bleeding,hemoglobin,baseline heart rate,low molecular weight heparin after PCI,and tirofiban after PCI(P<0.05).(2)In the case group,patients with melena as the first symptom accounted for 82.76%,hematemesis as the first symptom accounted for 6.90%,and hematemesis and melena as the first symptom accounted for 10.34%.In the case group,45 patients received gastrointestinal endoscopy,including 28.89% of gastric ulcer with bleeding,17.78% of duodenal ulcer with bleeding,22.22% of chronic gastritis with erosive bleeding,20.00% of gastric ulcer with duodenal ulcer bleeding,11.11% of chronic gastritis with duodenal ulcer bleeding,and 13 patients did not receive gastrointestinal endoscopy.The incidence of gastrointestinal bleeding after PCI was 60.34% within 1 month,13.79% within 2-3months,6.90% within 4-6 months and 18.97% within 7-12 months.(3)The PRECISE-DAPT score and CRUSADE score of the case group were higher than those of the control group,and the difference was statistically significant(P<0.05).The PRECISE-DAPT score is closely related to gastrointestinal bleeding after PCI(OR=1.094,P<0.001,95%CI:1.063-1.126).CRUSADE score is closely related to gastrointestinal bleeding after PCI(OR=1.091,P<0.001,95%CI:1.059-1.123).(4)The area under the ROC curve of PRECISE-DAPT score is 0.786(95%CI:0.729-0.843),the best cut-off value is 20.5 points,the sensitivity is 0.879,the specificity is 0.655,and the Yorden Index is 0.534.The area under the ROC curve of the CRUSADE score is 0.734(95%CI:0.655-0.812),the best cut-off point is 25.5 points,the sensitivity is 0.621,the specificity is 0.772,and the Yorden Index is 0.393.The difference in the area under the ROC curve between PRECISE-DAPT score and CRUSADE score was 0.052,and the difference was not statistically significant(P>0.05).(5)Analysis of risk factors for gastrointestinal bleeding after PCI: history of digestive system disease,history of chronic renal insufficiency,history of bleeding,low molecular weight heparin after PCI,use after PCI Tirofiban was a risk factor for gastrointestinal bleeding after PCI in ACS patients(P<0.05).(6)Area under ROC curve: the area under ROC curve of PRECISE-DAPT score was 0.786(95% CI:0.729-0.843),the best cutoff value was 20.5score,the sensitivity was 0.879,the specificity was 0.655,and the accuracy was 0.534.The area under the ROC curve of CRUSADE score was 0.734(95% CI:0.655-0.812),the best cutoff value was 25.5 score,the sensitivity was 0.621,the specificity was 0.772,and the accuracy was 0.393.The difference of area under ROC curve between PRECISE-DAPT score and CRUSADE score was 0.052,P=0.190.Conclusion: The PRECISE-DAPT score has predictive value for gastrointestinal bleeding events in ACS patients within 1 year after PCI.