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Long-term MACE and bleeding risk prediction using 4-item PRECISE-DAPT vs. DAPT scores in PCI patients with achieved
1Department of Cardiology, Daegu Catholic University Medical Center, Daegu, Republic of Korea.
Insights
The PRECISE-DAPT score better predicts major adverse cardiovascular events and bleeding in patients with low LDL-C after PCI compared to the DAPT score. This finding is crucial for managing patients post-percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- Dual antiplatelet therapy (DAPT) and PRECISE-DAPT scores predict bleeding post-percutaneous coronary intervention (PCI).
- Limited data exist on their predictive value in patients with low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL.
- This study evaluates these scores in a specific low LDL-C population post-PCI.
Purpose of the Study:
- To assess the long-term predictive power of the DAPT and 4-item PRECISE-DAPT scores.
- To compare their effectiveness in predicting major adverse cardiovascular events (MACE) and bleeding.
- Focus on patients with LDL-C < 70 mg/dL after PCI.
Main Methods:
- Included 403 patients with LDL-C < 70 mg/dL post-PCI.
- Compared MACE and bleeding events based on high (≥25) vs. low (<25) 4-item PRECISE-DAPT scores.
- Compared MACE and bleeding events based on high (≥2) vs. low (<2) DAPT scores.
Main Results:
- High PRECISE-DAPT scores correlated with significantly lower MACE-free survival (52.8% vs. 67.0%, p=0.03) and bleeding-free survival (77.8% vs. 97.5%, p<0.0001).
- DAPT score stratification showed no significant difference in MACE-free survival (64.7% vs. 66.7%, p=0.638).
- High DAPT scores showed significantly lower bleeding-free survival (91.6% vs. 99.5%, p<0.0001).
Conclusions:
- The PRECISE-DAPT score demonstrated superior long-term predictive ability for both MACE and bleeding events.
- This holds true for patients achieving LDL-C ≤ 70 mg/dL after PCI.
- PRECISE-DAPT score is more effective than DAPT score in this specific patient cohort.
Background And Aims:
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.
Methods:
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).
Results:
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).
Conclusions:
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.
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