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Performance of PRECISE-DAPT and Age-Bleeding-Organ Dysfunction Score for Predicting Bleeding Complication During Dual
Liang Dong1, Cao Lu1, Chen Wensen2
1Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Insights
The PRECISE-DAPT score and the Age-Bleeding-Organ Dysfunction (ABO) score show similar predictive performance for major bleeding in elderly Chinese patients undergoing percutaneous coronary intervention (PCI). The PRECISE-DAPT score may be more clinically applicable due to its simplicity.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- The Age-Bleeding-Organ Dysfunction (ABO) algorithm is a recent recommendation for evaluating bleeding risk.
- This study compares the PRECISE-DAPT and ABO bleeding scores in Chinese elderly patients post-percutaneous coronary intervention (PCI).
Purpose of the Study:
- To compare the predictive performance of the PRECISE-DAPT and ABO bleeding scores.
- To identify the risk of 12-month major bleeding in elderly Chinese patients (≥65 years) on dual-antiplatelet therapy (DAPT) after PCI.
Main Methods:
- A total of 2,037 elderly patients with coronary artery disease (CAD) after PCI were analyzed.
- The predictive accuracy of PRECISE-DAPT and ABO scores for major clinically relevant bleeding (defined by Bleeding Academic Research Consortium [BARC] criteria) was compared.
- Statistical analysis included C-statistics and goodness-of-fit tests.
Main Results:
- Both PRECISE-DAPT and ABO scores demonstrated significant differences across bleeding severity groups (BARC=1, BARC≥2).
- The C-statistics for predicting BARC ≥ 2 bleeding were similar for both scores (overall and in acute coronary syndrome patients).
- No significant differences were found between the ABO and PRECISE-DAPT models in overall or ACS patients, with acceptable calibration for both.
Conclusions:
- The PRECISE-DAPT and ABO scores exhibit similar discriminative ability for 12-month BARC ≥ 2 bleeding in elderly Asian patients on DAPT.
- The PRECISE-DAPT score is suggested as potentially more clinically applicable due to its simplicity and reliability for bleeding prediction in this population.
Background:
Recently, the Age-Bleeding-Organ Dysfunction (ABO) algorithm was recommended by the Asian Pacific Society of Cardiology Consensus as a binary approach to evaluate bleeding risk. This analysis made comparison of the predictive performances between the PRECISE-DAPT and ABO bleeding score in identifying the risk of 12-months major bleeding in Chinese elderly patients over 65 years old patients who underwent percutaneous coronary intervention (PCI) during dual-antiplatelet therapy period.
Methods:
A total of 2,037 elderly coronary artery disease (CAD) patients (≥65 years) receiving dual antiplatelet therapy (DAPT) after PCI were enrolled in the study. The predictive accuracy of the two bleeding risk scores (PRECISE-DAPT and ABO) was compared for identifying the risk of bleeding during the dual-antiplatelet therapy in patients who underwent PCI. Major clinically relevant bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) criteria.
Results:
The PRECISE-DAPT score in the no bleeding, BARC = 1 bleeding, BARC ≥ 2 bleeding patients was 23.55 ± 10.46, 23.23 ± 10.03, and 33.54 ± 14.33 (p < 0.001), respectively. Meanwhile, the ABO score in the three groups was 0.72 ± 0.80, 0.69 ± 0.81, and 1.49 ± 0.99 (p < 0.001), respectively. The C-statistic of the PRECISE-DAPT model for prediction of BARC ≥ 2 bleeding in overall patients was 0.717 (95% CI, 0.656-0.777) and 0.720 (95% CI, 0.656-0.784) in acute coronary syndrome (ACS) patients. Similar discriminatory capacity was demonstrated in the ABO risk score [overall, patients, AUC: 0.712 (95% CI, 0.650-0.774); ACS patients, AUC: 0.703 (95% CI, 0.634-0.772)]. No differences were observed when the ABO model was in comparison with the PRECISE-DAPT model, regardless in overall patients (z = -0.199, p = 0.842) or ACS patients (z = -0.605, p = 0.545). The calibration for BARC ≥ 2 bleeding of the PRECISE-DAPT and ABO score were acceptable, regardless in overall patients [goodness-of-fit (GOF) Chi-square = 0.432 and 0.001, respectively; p-value = 0.806 and 0.999, respectively] or ACS patients (GOF Chi-square = 0.008 and 0.580, respectively; p-value = 0.996 and 0.748, respectively).
Conclusion:
No matter of clinical presentation in Asian 65-years older patients with DAPT, the PRECISE-DAPT, and ABO scores had the similar discriminative ability for 12-months BARC ≥ 2 bleeding. Considering the simplicity and reliability, the PRECISE-DAPT score might be more clinically applicable in the overall population and ACS patients in bleeding prediction.
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