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Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI
Lisa Dannenberg1, Shazia Afzal1, Natalia Czychy1
1Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany.
Insights
The PRECISE-DAPT (PD) score accurately predicts bleeding risk and ischemic events in patients after percutaneous coronary intervention (PCI). This score helps tailor dual antiplatelet therapy duration, balancing bleeding and ischemic event risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Guidelines recommend the PRECISE-DAPT (PD) score to guide dual antiplatelet therapy (DAPT) duration based on bleeding risk.
- Emerging evidence suggests the PD score may also predict mortality and ischemic events.
Purpose of the Study:
- To investigate the predictive value of the PD score for bleeding and major adverse cardiac and cerebrovascular events (MACCE) in patients post-percutaneous coronary intervention (PCI).
- To assess the accuracy of the PD score in identifying patients at high risk for adverse outcomes.
Main Methods:
- A cohort of 994 patients undergoing PCI was analyzed.
- The PD score was correlated with established clinical scores.
- Major bleeding (Thrombolysis in Myocardial Infarction [TIMI] bleeding) and MACCE were assessed over a one-year follow-up period.
Main Results:
- Patients with a PD score ≥ 25 (47%) had significantly higher rates of major and minor bleeding compared to those with a PD score < 25.
- Higher rates of MACCE, death, and myocardial infarction were observed in the higher PD score group.
- The PD score demonstrated good discriminative ability (AUC > 0.6) for predicting bleeding, MACCE, death, and myocardial infarction.
Conclusions:
- The PD score is a valuable tool for predicting bleeding risk in post-PCI patients.
- The PD score also effectively predicts ischemic events, including death and myocardial infarction.
- While the PD score aids in optimizing DAPT duration, clinical decisions must consider individual patient risks for both bleeding and ischemic events.
Background:
Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well.
Methods:
We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up.
Results:
524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01-8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36-9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52-2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12-5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26-3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden's index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24).
Conclusion:
In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events.
