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PRECISE-DAPT and ARC-HBR Predict in-Hospital Outcomes in Patients Who Underwent Percutaneous Coronary Intervention
Vishnu Kadiyala1, Sokunvichet Long1, Phinnara Has1
1Division of Cardiology, Lifespan Cardiovascular Institute, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Insights
High bleeding risk scores, including PRECISE-DAPT and ARC-HBR, identify patients undergoing percutaneous coronary intervention (PCI) at increased risk for in-hospital bleeding and adverse events. These scores offer moderate predictive ability, regardless of gender.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Bleeding complications are a significant cause of morbidity and mortality following percutaneous coronary intervention (PCI).
- Accurate prediction of bleeding risk is crucial for optimizing patient management after PCI and stent implantation.
- Limited data exist on the predictive performance of established bleeding risk scores in the context of in-hospital outcomes post-PCI.
Purpose of the Study:
- To evaluate the ability of the PRECISE-DAPT (Predicting bleeding complications after discharge on dual antiplatelet therapy) and ARC-HBR (Academic Research Consortium for High Bleeding Risk) scores to predict in-hospital bleeding events.
- To assess the association of these scores with major adverse cardiovascular events (MACE) and net adverse clinical events (NACE) after PCI.
- To compare the predictive performance of the PRECISE-DAPT and ARC-HBR scores in patients undergoing PCI.
Main Methods:
- A retrospective analysis of consecutive patients who underwent PCI at tertiary centers between January 2016 and March 2018.
- Calculation of PRECISE-DAPT and ARC-HBR scores for all identified patients.
- Primary endpoint: National Cardiovascular Data Registry-defined in-hospital bleeding, stratified by low versus high predicted bleeding risk. Secondary endpoints included MACE and NACE.
- Receiver operating characteristic (ROC) curves were used to determine the discriminatory ability of the risk models.
Main Results:
- Among 3,659 patients, the in-hospital major bleeding rate was 3.3%.
- Patients classified as high bleeding risk by either ARC-HBR or PRECISE-DAPT criteria exhibited significantly higher bleeding rates (ARC-HBR: 5.4%; PRECISE-DAPT: 5.8%) compared to low-risk patients.
- Both scores demonstrated moderate and similar predictive ability (AUC for ARC-HBR high-risk: 0.62; AUC for PRECISE-DAPT ≥25: 0.61), with no added benefit from combining them. Women had higher bleeding rates than men, but predictive accuracy was similar across genders.
Conclusions:
- Patients identified as high bleeding risk by PRECISE-DAPT and ARC-HBR scores before PCI are at elevated risk for in-hospital bleeding and adverse outcomes, irrespective of gender.
- The PRECISE-DAPT and ARC-HBR scores possess moderate predictive capabilities for in-hospital bleeding events after PCI.
- Further research is warranted to develop and validate strategies aimed at mitigating bleeding risk in this high-risk patient population.
Abstract:
Bleeding events result in morbidity and mortality in patients who underwent percutaneous coronary intervention (PCI). There are limited data on the predicting bleeding complications in patients who underwent stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) and Academic Research Consortium for High Bleeding Risk (ARC-HBR) scores' ability to predict in-hospital outcomes in patients who underwent PCI. Consecutive patients who underwent PCI at tertiary centers from January 2016 to March 2018 were identified and the bleeding risk scores were calculated. The primary end point was the National Cardiovascular Data Registry-defined in-hospital bleeding stratified by low versus high predicted bleeding risk. The major and net adverse cardiovascular events were also examined. The discriminatory ability of the risk models was determined using receiver operating characteristic curves. Among 3,659 patients studied, the in-hospital major bleeding was 3.3% (n = 121). The patients characterized as high bleeding risk by either criterion had significantly higher bleeding rates than those meeting the low-risk criteria (ARC-HBR 5.4% vs 3.3%, p <0.001; PRECISE-DAPT 5.8% vs 2.4%, p <0.001), and higher major adverse cardiovascular events and net adverse clinical events. These risk estimates showed moderate and similar predictive ability (ARC-HBR high-risk area under the receiver operating characteristic curve [AUC] 0.62, PRECISE-DAPT ≥25 AUC 0.61, p = 0.49), with no incremental benefit to adding the estimates (AUC 0.60). The subgroup analysis revealed that women had higher bleeding rates than men (5.53% vs 2.39%, p <0.001); however, the predictive ability of the criteria were similar in women and men. The patients identified as having a high bleeding risk by the PRECISE-DAPT and the ARC-HBR criteria before PCI are at high risk for in-hospital bleeding and adverse outcomes independent of gender. The 2 scores have moderate predictive ability for bleeds. Further study is needed to determine strategies to reduce risk in this population.
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