Prognostic Role of the PRECISE-DAPT Score in Acute Coronary Syndrome and Different Antithrombotic Treatment
Dávid Bauer1, Adam Fojtík2, Vojtěch Berka2
1Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech Republic. david.bauer@fnkv.cz.
Insights
The PRECISE-DAPT score effectively predicts mid-term mortality in acute coronary syndrome (ACS) patients, particularly those with ST-elevation myocardial infarction (STEMI). This score maintains prognostic performance across various antithrombotic strategies.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Outcomes Research
Background:
- The PRECISE-DAPT score is established for predicting bleeding risk post-percutaneous coronary intervention (PCI) with dual antiplatelet therapy.
- Its utility as a mid-term mortality predictor in acute coronary syndrome (ACS) requires validation.
Purpose of the Study:
- To validate the PRECISE-DAPT score for predicting mid-term all-cause mortality in patients with ACS.
- To assess the score's predictive performance across different ACS subtypes and antithrombotic strategies.
Main Methods:
- Analysis of 2953 ACS patients hospitalized between October 2018 and October 2023.
- Utilized receiver operating characteristic (ROC) curve analysis to evaluate the PRECISE-DAPT score's predictive accuracy for mortality (mean follow-up 1.9 years).
- Calculated Area Under the Curve (AUC) for various ACS subtypes and discharge antithrombotic regimens.
Main Results:
- The PRECISE-DAPT score demonstrated the highest predictive ability for mortality in ST-elevation myocardial infarction (STEMI) patients (AUC=0.84).
- Predictive performance was lower for non-ST-elevation myocardial infarction (NSTEMI) (AUC=0.78) and unstable angina pectoris (UAP) (AUC=0.75).
- Discharge antithrombotic strategy (dual antiplatelet, dual antithrombotic, or triple therapy) did not significantly influence the score's predictive ability (p=0.61).
Conclusions:
- The PRECISE-DAPT score is a viable tool for predicting mid-term mortality in ACS patients, especially STEMI.
- The standard threshold (≥25) shows acceptable prognostic performance irrespective of the antithrombotic treatment strategy employed at discharge.
Introduction:
The PRECISE-DAPT score is a useful tool for predicting the risk of bleeding after percutaneous coronary intervention (PCI) requiring dual antiplatelet therapy. We aimed to validate the PRECISE-DAPT score as a mid-term mortality predictor in acute coronary syndrome (ACS).
Methods:
All patients with ACS hospitalized between October 2018 and October 2023 were analyzed. Mortality data were acquired in cooperation with the Institute of Health Information and Statistics of the Czech Republic. We used a standard PRECISE-DAPT threshold ≥ 25. A receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of the PRECISE-DAPT score for mortality with a mean follow-up of 1.9 years. Area under the curve (AUC) was calculated for each ACS subtype and different antithrombotic strategy regimes at discharge to quantify discrimination ability, with higher values indicating better prediction.
Results:
We included 2953 patients with ACS. There were mostly men (69.1%, n = 2040), 37.1% ST-elevation myocardial infarction (STEMI, n = 1095), 45.2% non-ST-elevation myocardial infarction (NSTEMI, n = 1336) and 17.7% unstable angina pectoris (UAP, n = 522) patients. The mean age was 67.4 (SD 12.5) years. There were 78.4% patients treated by PCI (n = 2314). The PRECISE-DAPT score best predicts mortality in STEMI, AUC = 0.84 (95% confidence interval [CI] from 0.82 to 0.87), while its predictive ability is lower for NSTEMI, 0.78 (95% CI from 0.76 to 0.80) and UAP 0.75 (95% CI from 0.71 to 0.79). Antithrombotic treatment strategy at discharge does not influence the predictive ability of the PRECISE-DAPT score (AUC = 0.78, 071 and 0.72 for dual antiplatelet therapy, dual antithrombotic therapy, and triple therapy, respectively), p = 0.61.
Conclusions:
The PRECISE-DAPT score may be used for predicting mid-term all-cause mortality in acute coronary syndrome, with the best predictive ability in STEMI. The standard threshold ≥ 25 maintain acceptable prognostic performance regardless of antithrombotic treatment strategy at discharge.
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