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Validation of High-Risk Features for Stent-Related Ischemic Events as Endorsed by the 2017 DAPT Guidelines
Yasushi Ueki1, Alexios Karagiannis2, Christian Zanchin1
1Department of Cardiology, Bern University Hospital, Bern, Switzerland.
Insights
European Society of Cardiology high-risk features predict increased ischemic and bleeding events after percutaneous coronary intervention. These findings are crucial for risk stratification in patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- The 2017 European Society of Cardiology guidelines identify high-risk features for stent-related ischemic events.
- Accurate risk stratification for both ischemic and bleeding events is essential due to the inherent link between high ischemic risk and increased bleeding risk.
Purpose of the Study:
- To validate European Society of Cardiology (ESC) guideline-endorsed high-risk features for predicting ischemic and bleeding outcomes.
- To stratify these risks based on the PRECISE-DAPT score for bleeding risk.
Main Methods:
- Prospective inclusion of 10,236 patients undergoing percutaneous coronary intervention (PCI) in the Bern PCI Registry (2009-2015).
- Retrospective assessment of ESC guideline-endorsed high-risk features.
- Primary endpoints: device-oriented composite endpoint (DOCE) and Bleeding Academic Research Consortium (BARC) 3-5 bleeding at 1 year.
Main Results:
- 52.0% of patients had at least one high-risk feature.
- Patients with high-risk features showed significantly higher rates of DOCE (12.3% vs. 5.5%) and BARC 3-5 bleeding (4.9% vs. 2.2%) compared to those without.
- A graded increase in risk for both DOCE and BARC 3-5 bleeding was observed with an increasing number of high-risk features.
- High PRECISE-DAPT score (≥25) correlated with increased DOCE and BARC 3-5 bleeding, irrespective of the number of high-risk features.
Conclusions:
- ESC guideline-endorsed high-risk features are associated with elevated ischemic and bleeding risks in real-world PCI practice.
- These features aid in predicting outcomes following percutaneous coronary intervention.
- (CARDIOBASE Bern PCI Registry; NCT02241291)
Objectives:
This study sought to validate European Society of Cardiology guideline-endorsed high-risk features of stent-related recurrent ischemic events for the prediction of ischemic and bleeding outcomes including a stratification according to the PRECISE-DAPT score estimated bleeding risk.
Background:
The 2017 European Society of Cardiology-focused update on dual-antiplatelet therapy endorsed high-risk features of stent-related recurrent ischemic events. Because patients with high ischemic risk also have an increased bleeding risk, appropriate risk stratification for ischemic and bleeding events is crucial.
Methods:
Between January 2009 and December 2015, a total of 10,236 consecutive patients undergoing clinically indicated percutaneous coronary intervention were prospectively included in the Bern PCI Registry. Guideline-endorsed high-risk features were retrospectively assessed. The primary ischemic endpoint was device-oriented composite endpoint (DOCE) (cardiac death, target-vessel myocardial infarction, and target lesion revascularization) at 1 year, and the primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) 3-5 at 1 year.
Results:
A total of 5,323 (52.0%) patients had at least 1 high-risk feature. Among patients with high-risk features, DOCE (12.3% vs. 5.5%; p < 0.001) and BARC 3-5 bleeding (4.9% vs. 2.2%; p < 0.001) occurred more frequently compared with those without. There was a graded risk increase for DOCE (0: 5.5%; 1 to 2: 11.3%; and ≥3: 16.7%; p < 0.001) and BARC 3-5 bleeding (0: 2.2%; 1 to 2: 4.5%; and ≥3: 6.6%; p < 0.001) as the number of high-risk features increased. High-PRECISE-DAPT score (≥25) was associated with an increased risk of DOCE and BARC 3-5 bleeding, irrespective of number of high-risk features.
Conclusions:
The European Society of Cardiology guideline-endorsed high-risk features were associated with increased ischemic and bleeding risks following percutaneous coronary intervention in routine clinical practice. (CARDIOBASE Bern PCI Registry; NCT02241291).
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