运用CRUSADE评分系统评估非ST段抬高性急性冠脉综合征患者双重抗血小板治疗后的出血风险简

目的 运用CRUSADE评分系统对非ST段抬高性急性冠脉综合征（non-ST-elevation acute coronary syndromes,NSTE-ACS）患者抗栓治疗后的出血风险进行评估.方法 选择2009年1月至2011年6月在清华大学第一附属医院住院的NSTE-ACS患者共245例,对每例患者行CRUSADE评分并进行危险分层,其中包括不稳定型心绞痛（unstable angina,UA）患者115例男68例,女47例,年龄为（63.5±3.6）岁],非ST段抬高性心肌梗死（non-ST-elevation myocardial infarction,NSTEMI）患者130例男79例,女51例,年龄为（66.2±9.1）岁].所有患者均服用双重抗血小板药物（阿司匹林与氯吡格雷联用）1年,观察期间的出血发生率.结果 245例NSTE-ACS患者中共有23例发生主要出血事件,出血发生率为9％,其中消化道出血的发生率最高,占整个出血人群的50％以上,其次为泌尿系统出血,脑出血和肺出血发生率相对较低.在115例UA患者中1年内共有7例发生了主要出血事件,总的出血发生率为6％,由极低危组到极高危组出血发生率依次为0％、0％、0.9％、1.7％、3.5％;130例NSTEMI患者中1年内有16例发生了主要出血事件,总的出血发生率为12％,由极低危组到极高危组出血发生率依次为0.8％、0.8％、1.5％、3.1％、6.0％.高危组和极高危组的出血风险显著高于其余各组,差异有统计学意义（P＜0.05）.结论 随着危险分层级别（CRUSADE评分）增大,出血发生率呈增加趋势,CRUSADE评分系统对于NSTE-ACS患者出院后长期双联抗血小板治疗的出血风险有良好的评估价值.

Application of CRUSADE scoring system in assessment of hemorrhage in patients with non-ST-elevation acute coronary syndromes after percutaneous coronary intervention

Objectives To evaluate the application of CRUSADE scoring system in prediction of hemorrhage in patients with non-ST-elevation acute coronary syndromes （NSTE-ACS） after percutaneous coronary intervention （PCI）.Methods CRUSADE scoring system was conducted in randomly collected 245 patients with NSTE-ACS who had PCI therapy in The First Affiliated Hospital of Tsing Hua University from January 2009 to June 2011.The patients were divided into unstableangina （UA） group n=115,68 males and 47 females,（63.5±3.6） years] and non-ST-elevation myocardial infarction （NSTEMI） group n=130,79 males and 51 females,（66.2±9.1） years].All patients took aspirin and clopidogrel for 1 year.Incidence of hemorrhage was observed during the period.Results There were 23 patients with obvious hemorrhage in the 245 NSTE-ACS patients,and the bleeding rate was 9％.The highest hemorrhage incidence was gastrointestinal events （＞50％）,followed by urinary tract hemorrhage.Cerebral hemorrhage and pulmonary hemorrhage incidence rates were relatively low.There were 7 patients with obvious hemorrhage in the 115 UA patients during the observation period,and the incidence of hemorrhage was 6％.Hemorrhage incidence rates from extremely-low-risk group to extremely-high-risk group were 0％,0％,0.9％,1.7％,3.5％.There were 16 patients with obvious hemorrhage in the 130 NSTEMI patients during the observation period,and the incidence of hemorrhage was 12％.Hemorrhage incidence rates from extremely-low-risk group to extremely-high-risk group were 0.8％,0.8％,1.5％,3.1％,6.0％.Hemorrhage incidence rates in extremely-high-risk and high-risk groups were significantly higher than those in other groups （P＜0.05）.Conclusions The incidence rate of hemorrhage escalates with the increase of CRUSADE score.CRUSADE scoring system is valuable in the assessment of the hemorrhage incidence in patients with NSTE-ACS after PCI.