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The four-item PRECISE-DAPT score identifies coronary artery bypass grafting patients with increased risk for
Philip Enström1,2, Andreas Martinsson2,3, Mary Rezk1,2
1Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg 41345, Sweden.
Insights
The PRECISE-DAPT score moderately identifies major bleeding risk in patients after coronary artery bypass grafting (CABG). This score aids in personalizing antithrombotic therapy for improved patient outcomes.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Early identification of bleeding risk is crucial for tailoring antithrombotic therapy.
- The PRECISE-DAPT score was developed to assess bleeding risk in patients undergoing percutaneous coronary intervention (PCI).
- Validation in coronary artery bypass grafting (CABG) patients is needed.
Purpose of the Study:
- To validate the PRECISE-DAPT score for estimating bleeding risk in patients after CABG.
- To assess the score's accuracy in identifying patients at high risk for major bleeding post-discharge.
Main Methods:
- A cohort of isolated CABG patients in Sweden (2009-2020) who survived discharge was analyzed.
- The four-item PRECISE-DAPT score was calculated for patients on dual antiplatelet therapy (DAPT) or monotherapy.
- Major bleeding was defined as hospitalization due to bleeding; associations were assessed using C-statistics and Cox regression.
Main Results:
- Major bleeding occurred in 1.9% of DAPT patients and 1.3% of monotherapy patients within the first year post-discharge.
- The PRECISE-DAPT score identified 32.9% of DAPT patients and 38.2% of monotherapy patients as high bleeding risk.
- The area under the ROC curve was 0.67 for DAPT and 0.71 for monotherapy, with significant hazard ratios for high bleeding risk.
Conclusions:
- The PRECISE-DAPT score demonstrates moderate accuracy in identifying major bleeding risk post-CABG.
- The score's predictive performance in CABG patients is comparable to that observed in PCI patients.
- This validation supports the potential use of the PRECISE-DAPT score for risk stratification in CABG patients.
Aims:
Early identification of patients with increased bleeding risk increases the possibility to individualize antithrombotic treatment. We validated the PRECISE-DAPT score, originally developed to estimate bleeding risk in patients on dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), in coronary artery bypass grafting (CABG) patients.
Methods And Results:
All patients who underwent the first time, isolated CABG in Sweden 2009-2020 and survived until discharge were included. The four-item PRECISE-DAPT score, based on age, estimated glomerular filtration rate, pre-operative haemoglobin concentration, and previous spontaneous bleeding, was calculated in patients discharged on DAPT (n = 6838), or antiplatelet monotherapy (n = 15 406). High bleeding risk was defined as a score ≥25 in accordance with previous studies and major bleeding as hospitalization due to bleeding. Associations were assessed by C-statistics and Cox regression models. Major bleeding occurred during the first post-operative year in 130 patients (1.9%) in the DAPT group, and in 197 patients (1.3%) in the monotherapy group. The score identified 32.9% of the patients in the DAPT group and 38.2% in the monotherapy groups as having high bleeding risk. The area under the ROC-curve for the score was 0.67 (95%CI 0.62-0.72) for DAPT and 0.71 (0.67-0.74) for monotherapy. The hazard ratio for high bleeding risk vs. very low risk was 4.14 (2.07-8.26) for DAPT patients, and 4.95 (2.61-9.39) for monotherapy patients, both P < 0.001.
Conclusion:
The PRECISE-DAPT identifies patients with increased risk for major bleeding after discharge following CABG with moderate accuracy. The accuracy is comparable to what previously has been reported for patients after PCI.
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