Precise Score Validation in Buenos Aires 1 Registry

Area of Science:

• Cardiology
• Clinical Risk Prediction

Background:

• Dual antiplatelet therapy (DAPT) is crucial after percutaneous coronary intervention (PCI).
• Predicting bleeding risk in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) on DAPT is essential for optimal management.

Purpose of the Study:

• To evaluate the predictive performance of the PRECISE-DAPT score for bleeding events and major adverse cardiovascular events (MACE) in NSTE-ACS patients undergoing DAPT.
• To assess the utility of the PRECISE-DAPT score in identifying high-risk patient subgroups.

Main Methods:

• Analysis of 862 NSTE-ACS patients from the Buenos Aires 1 registry.
• Calculation of the PRECISE-DAPT score upon admission.
• 15-month follow-up to assess bleeding events (BARC 2, 3, or 5) and MACE.
• Evaluation of the score as both a continuous and dichotomous variable (≥25).

Main Results:

• As a continuous variable, the PRECISE-DAPT score showed low to moderate predictive ability for BARC 2, 3, or 5 bleeding (c-statistic 0.58) and moderate ability for BARC 3 or 5 bleeding (c-statistic 0.72).
• The score demonstrated poor prediction for MACE (c-statistic 0.49).
• A dichotomous PRECISE-DAPT score ≥25 (24% of patients) was associated with significantly higher risks of both bleeding (HR 2.1) and ischemic events (HR 1.9).

Conclusions:

• The PRECISE-DAPT score, particularly when dichotomized at ≥25, effectively identifies a subgroup of NSTE-ACS patients at high risk for both bleeding and thrombotic events.
• This score can aid clinicians in tailoring DAPT duration and intensity in high-risk NSTE-ACS populations.