本研究评估了将癌症作为预测因素对 PRECISE-DAPT 评分表现的影响。2005 年 1 月 1 日至 2019 年 3 月 31 日之间的全国性 ST 段抬高型心肌梗死患者队列源自英国心肌缺血国家审计项目，英国医院病例统计承认患者护理登记处。主要结局是一年时大出血。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，生成新的修改评分，并将其性能与原始 PRECISE-DAPT 评分进行比较。总共纳入了 216 709 名 ST 抬高型心肌梗死患者，其中4569人患有癌症。原始评分显示出中等准确性（C-统计量 0.60），修改后的评分显示出较高的辨别力（C-统计量 0.64；风险比 1.03，95% 置信区间 1.03-1.04），即使在没有癌症的患者中也是如此（C-统计量） .63；风险比 1.03，95% 置信区间 1.03-1.04)。净重新分类指数为 0.07。修正评分风险类别（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%的癌症患者被归类为低或极低出血风险。根据修改后的评分，94.0%的癌症患者为HBR，6.0%为中度出血风险，没有癌症患者被归类为低或极低出血风险。将癌症添加到PRECISE-DAPT评分中可识别大多数癌症患者与 HBR 一样，可以在不损害其在非癌症患者中的表现的情况下提高其辨别能力。© 作者 2024。由牛津大学出版社代表欧洲心脏病学会出版。

This study assessed the impact of incorporating cancer as a predictor on performance of the PRECISE-DAPT score.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.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.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.© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.