Discordance and Performance of the ARC-HBR and PRECISE-DAPT High Bleeding Risk Definitions After Coronary Stenting

Area of Science:

• Cardiology
• Clinical Risk Stratification
• Pharmacotherapy

Background:

• High bleeding risk definitions aim to tailor antiplatelet therapy post-coronary stenting.
• ARC-HBR and PRECISE-DAPT scores are established tools for identifying such patients.

Purpose of the Study:

• To evaluate the real-world performance of ARC-HBR and PRECISE-DAPT scores.
• To assess their accuracy in predicting bleeding and ischemic events.

Main Methods:

• Nationwide registry data from Stockholm, Sweden (2013-2018).
• Inclusion of patients discharged post-coronary stenting on dual antiplatelet therapy.
• Categorization using ARC-HBR and PRECISE-DAPT, followed by 1-year event assessment (bleeding and ischemic).

Main Results:

• Substantial discordance observed between ARC-HBR (27%) and PRECISE-DAPT (38%) in high bleeding risk categorization.
• Both scores identified patients with elevated bleeding (BARC 3-5/TIMI major/minor) and ischemic risks.
• PRECISE-DAPT score demonstrated underestimation of bleeding risk.

Conclusions:

• Existing high bleeding risk definitions show significant discordance in clinical practice.
• Patients identified as high bleeding risk also exhibit higher ischemic risk.
• Refinement of current scoring systems is necessary for improved generalizability and accuracy.