A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making

Area of Science:

• Cardiology
• Clinical Risk Stratification
• Pharmacotherapy

Background:

• The PRECISE-DAPT score is a validated tool for guiding dual antiplatelet therapy (DAPT) duration post-percutaneous coronary intervention (PCI).
• The clinical utility of a simplified 4-item PRECISE-DAPT score, omitting white blood cell count, in guiding DAPT duration requires evaluation.
• Assessing the 4-item PRECISE-DAPT score's ability to stratify bleeding and ischemic risk in patients undergoing DAPT is crucial.

Discussion:

• Long-term DAPT increased bleeding in high bleeding risk (HBR) patients (PRECISE-DAPT ≥25) but not in non-HBR patients.
• Long-term DAPT reduced ischemic events in non-HBR patients, but not in HBR patients.
• Net clinical adverse events (NACE) were lower with longer DAPT only in non-HBR patients, suggesting risk-benefit differences based on bleeding risk.

Key Insights:

• The 4-item PRECISE-DAPT score successfully categorized patients into high and non-high bleeding risk groups.
• Patients categorized as non-HBR by the 4-item score benefited from prolonged DAPT with reduced ischemic events and NACE.
• Patients categorized as HBR by the 4-item score did not show similar benefits from prolonged DAPT, with increased bleeding risk.

Outlook:

• The simplified 4-item PRECISE-DAPT score demonstrates potential as a practical tool for personalized DAPT duration decisions.
• Further validation in diverse patient populations is warranted to confirm the 4-item score's generalizability.
• This simplified score may facilitate more precise clinical decision-making, optimizing treatment strategies and patient safety.