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PACE DRAP: a simple score for predicting significant bleeding complications after cardiac implantable electronic
Sylwia Sławek-Szmyt1, Aleksander Araszkiewicz2, Marek Grygier2
11st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland. sylwia.slawek@skpp.edu.pl
Insights
A new scoring system, PACE DRAP, effectively identifies patients at high risk for significant bleeding complications (SBCs) following cardiac implantable electronic device (CIED) surgery. This tool aids in risk stratification and clinical decision-making for CIED procedures.
Area of Science:
- Cardiology
- Medical Informatics
- Surgical Risk Assessment
Background:
- Significant bleeding complications (SBCs) are a risk after cardiac implantable electronic device (CIED) surgery.
- Currently, no validated risk score exists to predict SBCs in this patient population.
Purpose of the Study:
- To develop and validate a novel scoring system for predicting SBCs post-CIED surgery.
- To identify key predictors of SBCs in patients undergoing CIED procedures.
Main Methods:
- Multivariable logistic regression analysis was used to identify independent predictors of SBCs.
- A risk score (PACE DRAP) was developed based on weighted predictors and their regression coefficients.
- The predictive performance of the PACE DRAP score was evaluated using sensitivity, specificity, and area under the curve (AUC).
Main Results:
- The incidence of SBCs was 4.5%.
- Key predictors identified include advanced age (≥75 years), specific CIED procedures (CRT/ICD, upgrade), uncontrolled hypertension, valvular prosthesis, current malignancy, renal failure, and use of specific antiplatelet drugs (ticagrelor, clopidogrel).
- The PACE DRAP score demonstrated good predictive ability (AUC=0.95) with a cutoff of 6 points yielding 88.24% sensitivity and 87.23% specificity.
Conclusions:
- The PACE DRAP score is a valuable tool for identifying patients at high risk of SBCs after CIED surgery.
- This score can aid clinicians in risk stratification and potentially guide preventative strategies.
Introduction:
Currently, no risk score for predicting significant bleeding complications (SBCs) after cardiac implantable electronic device (CIED) surgery is available.
Objectives:
We aimed to develop a new scoring system for predicting SBCs aft er CIED surgery.
Patients And Methods:
The incidence of SBCs was 4.5%. Based on multivariable analyses, the following predictors of SBCs were identified: age ≥75 years (odds ratio [OR], 8.10; 95% CI, 3.54-18.54); cardiac resynchronization therapy or implantable cardioverter-defibrillator surgery (OR, 5.96; 95% CI, 2.48-14.32); upgrade procedure (OR, 10.22; 95% CI, 4.05-25.78); uncontrolled arterial hypertension (OR, 4.82; 95% CI, 1.78-13.06); presence of valvular prosthesis (OR, 7.85; 95% CI, 3.15-19.58); current malignancy (OR, 6.11; 95% CI, 1.81-20.66); renal failure (OR, 4.28; 95% CI, 1.86-9.87); and the use of antiplatelet drugs (clopidogrel [OR, 6.69; 95% CI, 2.48-18.04] or ticagrelor [OR, 22.25; 95% CI, 4.56-108.46]). The score was created using the weighted points proportional to the β regression coefficient of each predictor rounded to the nearest integer, and the acronym PACE DRAP corresponds to the predictor's first letter. The cutoff point for the high risk of SBCs was 6 points with a sensitivity of 88.24% and a specificity of 87.23%. The PACE DRAP showed good predictive ability (area under the curve, 0.95 ; P <0.001).
Conclusions:
The PACE DRAP score is useful in identifying patients at high risk for SBCs after CIED surgery.
