Background and Aims This study assessed the impact of incorporating cancer as a predictor on performance of the PRECISE-DAPT score. Methods A nationally linked cohort of ST-elevation myocardial infarction patients between 1 January 2005 and 31 March 2019 was derived from the UK Myocardial Ischaemia National Audit Project and the UK Hospital Episode Statistics Admitted Patient Care registries. The primary outcome was major bleeding at 1 year. A new modified score was generated by adding cancer as a binary variable to the PRECISE-DAPT score using a Cox regression model and compared its performance to the original PRECISE-DAPT score. Results A total of 216 709 ST-elevation myocardial infarction patients were included, of which 4569 had cancer. The original score showed moderate accuracy (C-statistic .60), and the modified score showed modestly higher discrimination (C-statistics .64; hazard ratio 1.03, 95% confidence interval 1.03–1.04) even in patients without cancer (C-statistics .63; hazard ratio 1.03, 95% confidence interval 1.03–1.04). The net reclassification index was .07. The bleeding rates of the modified score risk categories (high, moderate, low, and very low bleeding risk) were 6.3%, 3.8%, 2.9%, and 2.2%, respectively. According to the original score, 65.5% of cancer patients were classified as high bleeding risk (HBR) and 21.6% were low or very low bleeding risk. According to the modified score, 94.0% of cancer patients were HBR, 6.0% were moderate bleeding risk, and no cancer patient was classified as low or very low bleeding risk. Conclusions Adding cancer to the PRECISE-DAPT score identifies the majority of patients with cancer as HBR and can improve its discrimination ability without undermining its performance in patients without cancer.

中文翻译：

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急性心肌梗死整合癌症数据后出血风险预测：更新的 PRECISE-DAPT 癌症评分


背景和目的 本研究评估了将癌症作为预测因子对 PRECISE-DAPT 评分性能的影响。方法 2005 年 1 月 1 日至 2019 年 3 月 31 日期间 ST 段抬高型心肌梗死患者的全国关联队列来自英国心肌缺血国家审计项目和英国医院事件统计入院患者护理登记处。主要结局是 1 年时大出血。通过使用 Cox 回归模型将癌症作为二元变量添加到 PRECISE-DAPT 评分中，并将其性能与原始 PRECISE-DAPT 评分进行比较，从而生成新的修改分数。结果 共纳入 216 709 例 ST 段抬高型心肌梗死患者，其中 4569 例为癌症。原始评分显示中等准确性（C 统计量 .60），修改后的评分显示区分度略高（C 统计量 .64;风险比 1.03,95% 置信区间 1.03-1.04），即使在无癌症患者中也是如此（C 统计量 .63;风险比 1.03,95% 置信区间 1.03-1.04）。净重分类指数为 .07。改良评分风险类别 （高、中、低和极低出血风险） 的出血率分别为 6.3% 、 3.8% 、 2.9% 和 2.2%。根据原始评分，65.5% 的癌症患者被归类为高出血风险 （HBR），21.6% 被归类为低出血风险或极低出血风险。根据改良评分，94.0% 的癌症患者为 HBR，6.0% 为中度出血风险，无癌症患者被归类为低或极低出血风险。结论 将癌症添加到 PRECISE-DAPT 评分中可将大多数癌症患者识别为 HBR，并且可以在不损害其在非癌症患者中的表现的情况下提高其鉴别能力。