Long-term MACE and bleeding risk prediction using 4-item PRECISE-DAPT vs. DAPT scores in PCI patients with achieved...

The DAPT (dual antiplatelet therapy) and PRECISE-DAPT (Predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy) score have been developed to predict bleeding events after PCI (percutaneous coronary intervention). However, few studies have evaluated the predictive value of the DAPT and the 4-item PRECISE-DAPT score in patients whose low-density lipoprotein cholesterol (LDL-C) was below 70 mg/dL. Therefore, we performed this study to evaluate the long-term predictive power for MACE (major adverse cardiovascular events) and bleeding events with the 2 scores in patients whose LDL-C was below 70 mg/dL after PCI.

We included 403 PCI patients whose LDL-C was below 70 mg/dL at follow-up. We compared MACE and bleeding events between high and low 4-item PRECISE-DAPT scores (high: ≥ 25, low: < 25), and between high and low DAPT scores (high: ≥ 2, low: < 2).

Over a median follow-up of 106.0 months, 138 MACE and 17 bleeding events were recorded. Patients with high 4-item PRECISE-DAPT scores had significantly lower MACE-free survival compared with those with low scores (52.8 % vs. 67.0 %, p = 0.03) and markedly lower bleeding-free survival (77.8 % vs. 97.5 %, p < 0.0001). In contrast, when stratified by DAPT score, there was no significant difference in MACE-free survival between high and low groups (64.7 % vs. 66.7 %, p = 0.638), but bleeding-free survival was significantly lower in the high-score group (91.6 % vs. 99.5 %, p < 0.0001).

Among patients achieving LDL-C ≤ 70 mg/dL after PCI, the PRECISE-DAPT score was more effective than the DAPT score in predicting both long-term MACE and bleeding events.