Validation of the 4-Item PRECISE-DAPT Score: A SWEDEHEART Study

Area of Science:

• Cardiology
• Clinical Risk Prediction
• Pharmacology

Background:

• The PRECISE-DAPT score predicts major bleeding post-myocardial infarction (MI) with percutaneous coronary intervention and dual antiplatelet therapy (DAPT).
• Large-scale validation and real-world performance in high-risk patient subgroups remain under-evaluated.

Purpose of the Study:

• To validate the PRECISE-DAPT score's predictive accuracy for major bleeding in a real-world MI population.
• To assess the score's discriminative ability in patients with pre-existing bleeding risk factors.

Main Methods:

• Analysis of 66,295 patients from the SWEDEHEART registry undergoing PCI for MI (2008-2017).
• Evaluation of PRECISE-DAPT score's predictive value for rehospitalization due to major bleeding using receiver operating characteristic (ROC) analyses.
• Stratification of performance based on pre-existing bleeding risk factors (elderly, underweight, etc.).

Main Results:

• A high PRECISE-DAPT score (≥25) was associated with a significantly increased risk of major bleeding (3.9% vs 1.8%, HR 2.2).
• The overall score demonstrated moderate discriminative ability (c-statistic=0.64).
• Performance was poor in elderly (c-statistic=0.57) and underweight (c-statistic=0.56) patients, with limited ability to stratify bleeding risk.

Conclusions:

• The PRECISE-DAPT score shows moderate predictive value in the general MI population.
• Its utility is limited in patients with pre-existing bleeding risk factors, indicating a need for refined risk assessment tools.