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Updated: Dec 8, 2025
An R-Based Landscape Validation of a Competing Risk Model
Published on: September 16, 2022
Direct comparison of predictive performance of PRECISE-DAPT versus PARIS versus CREDO-Kyoto: a subanalysis of the
R Rozemeijer1, W P van Bezouwen2, N D van Hemert2
1Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. r.rozemeijer@umcutrecht.nl.
Insights
The CREDO-Kyoto score moderately predicts post-discharge ischemic or bleeding events after stenting, outperforming PARIS and PRECISE-DAPT scores in this patient group. Further research is needed to enhance risk stratification robustness.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Percutaneous coronary intervention (PCI) necessitates effective risk stratification tools.
- Existing scores like PRECISE-DAPT, PARIS, and CREDO-Kyoto aim to predict post-PCI ischemic or bleeding events.
- Independent validation of these scores is crucial for clinical utility.
Purpose of the Study:
- To evaluate and compare the predictive performance of the PRECISE-DAPT, PARIS, and CREDO-Kyoto risk scores.
- To assess the accuracy of these scores in identifying post-discharge ischemic and bleeding events following PCI.
- To determine the most reliable risk stratification tool in a contemporary patient cohort.
Main Methods:
- A cohort of 1491 patients undergoing latest-generation drug-eluting stent implantation was analyzed.
- PRECISE-DAPT, PARIS, and CREDO-Kyoto risk scores were calculated for each patient.
- Performance was assessed using calibration, Harrell's c-statistics, net reclassification index, and decision curve analyses.
Main Results:
- Post-discharge ischemic events occurred in 3.8% and bleeding events in 2.3% of patients within one year.
- CREDO-Kyoto demonstrated moderate discrimination for ischemic events (c-statistic 0.68) and bleeding events (c-statistic 0.67).
- PARIS and PRECISE-DAPT showed marginal discrimination for bleeding events, and PARIS for ischemic events.
Conclusions:
- The PARIS and PRECISE-DAPT scores lacked resilience in predicting post-discharge bleeding events in this cohort.
- The CREDO-Kyoto score offered moderate predictive capability for both ischemic and bleeding events.
- Improved risk stratification strategies with enhanced robustness and rigorous testing are warranted.
Background:
Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events.
Methods:
A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell's c‑statistics net reclassification index and decision curve analyses.
Results:
Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARIS ischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51-0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60-0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56-0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48-0.69) and PARIS (0.55, 95% CI 0.44-0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment.
Conclusion:
In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing.
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