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Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction

Carme Guerrero1, Albert Ariza-Solé1, Francesc Formiga2

  • 1Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona.

Journal of Geriatric Cardiology : JGC
|January 25, 2019
PubMed

Insights

The PRECISE-DAPT score may not accurately predict bleeding risk in elderly patients with acute coronary syndromes (ACS). Alternative cut-off points may be needed for better risk stratification in this population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Risk Stratification

Background:

  • Elderly patients with acute coronary syndromes (ACS) face elevated risks of both ischemic and bleeding complications.
  • Current guidelines suggest the PRECISE-DAPT score for bleeding risk assessment in ACS, but its effectiveness in elderly populations remains unevaluated.
  • This study investigates the PRECISE-DAPT score's performance in non-selected elderly ACS patients within routine clinical practice.

Purpose of the Study:

  • To evaluate the applicability and performance of the PRECISE-DAPT score in predicting bleeding risk among elderly patients (≥ 75 years) diagnosed with ST-segment elevation myocardial infarction (STEMI).

Main Methods:

  • The study utilized data from the IFFANIAM registry, including prospectively enrolled patients aged 75 years or older with STEMI.
  • Relevant bleeding events post-discharge were the primary outcome, defined by criteria such as hospital readmission, transfusion needs, interventions, cessation of antithrombotics, or death.
  • Bleeding risk was assessed using the PRECISE-DAPT score, categorized by the recommended cut-off (≥ 25) and by quartiles derived from the study cohort.

Main Results:

  • The study included 208 elderly patients with a mean age of 81.9 years.
  • A significant majority (92.6%) presented with PRECISE-DAPT scores exceeding the recommended threshold of 25.
  • While no significant difference in bleeding incidence was found based on the ≥ 25 cut-off, a progressive increase in bleeding events was observed across increasing PRECISE-DAPT quartiles (P = 0.038).

Conclusions:

  • The PRECISE-DAPT score's recommended cut-off of ≥ 25 is surpassed by most elderly ACS patients, limiting its discriminatory power.
  • The study suggests that utilizing alternative or customized cut-off points for the PRECISE-DAPT score may offer a more rational approach to predicting bleeding risk in this complex demographic.
  • Further research is warranted to refine bleeding risk stratification tools for elderly patients with ACS.
Abstract

Keywords:
Acute coronary syndromesBleedingPrognosisThe elderly

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