所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Clinical utility of PARIS score for the patients with atrial fibrillation undergoing PCI: a multicentre registry|
|主催者||The European Association of Percutaneous Cardiovascular Interventions (EAPCI) and The world-leading Course in Interventional Cardiovascular Medicine|
|発表者・共同発表者||◎OOTSUKI Hisao, YAMAGUCHI Junichi, TANAKA Kazuki, NAKAO Masashi, SHIMAZAKI Kensuke, JUJO Kentaro, ARASHI Hiroyuki, HAGIWARA Nobuhisa|
|概要||METHODS AND RESULTS:
Five hundred ninety two consecutive patientswith AF undergoing PCI from January 2011 to December 2014 were registered at 8 medical centers in Japan. Among them, 35 patients were excluded because of missing data for PARIS Score. Finally, 557 patients were examined. The study endpoints were incidence of major adverse cerebro-cardiovascular events (MACCE; All cause death, non-fatal myocardial infarction and stroke) and bleeding events (including TIMI criteria major and minor bleeding).
The mean age of whole study population was 73.3±8.8 years old, 79.4% of them were male, 41.4% of them were suffered from diabetes mellitus and 50.0% of them showed impaired renal function (eGFR<60 mL/min/1.73m2)). The mean CHADS2 score and HAS-BLED score were 2.4±1.3 and 2.5±0.9, respectively. The patients who took DAPT consisted of aspirin plus thienopyridine without oral anticoagulation were 31.8% and DAPT plus oral anticoagulation (triple therapy) were 64.4%.
Based on PARIS Score, the patients were scored for thrombotic risk and bleeding risk separately. To evaluate thrombotic risk, diabetes mellitus, acute coronary syndrome, current smoking, impaired renal function, prior PCI and prior CABG were scoring items. The scores ranged from 0 to 10, and patients were categorized at low (0 to 2), intermediate (3 or 4), and high (≥5) risk groups. The numbers of patient at low-, intermediate-, and high-risk group were 326 (58.5%), 159 (28.5%) and 72 (12.9%), respectively. Analogously, high age, body mass index, current smoking, anemia and triple therapy on discharge were the scoring items for bleeding risk. The range of scores was 0 to 14, and patients were also categorized at low (0 to 3), intermediate (4 to 7) and high (≥8) bleeding risk groups. The numbers of patient at low-, intermediate-, and high-risk group were 34 (6.1%), 306 (54.9%) and 217 (39.0%), respectively.
Kaplan-Meier analysis both on MACCE and bleeding events were performed separately. In terms of MACCE, three-year event rates were 13.8%, 16.9% and 39.4% in low-, intermediate- and high-risk group, respectively (Log-rank p<0.001). Cox proportional hazard analysis showed that high-risk group had a significantly worse clinical outcome compared with the other two groups. (high-risk vs. Intermediate-risk, hazard ratio 2.2, 95% confidence interval 1.17-4.03, p=0.01 and high-risk vs. low-risk, hazard ratio 2.7, 95% confidence interval 1.56-4.69, p<0.001). On the other hand, three-year bleeding event rates were 0.0%, 14.6% and 20.1% in low-, intermediate- and high-risk group, respectively (Log-rank p=0.047).
PARIS Score might be useful to evaluate the thrombotic and bleeding risk in patients with AF undergoing PCI, which were thought to be a high-risk subset in current daily practice.