Relationship between predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE‐DAPT) score and mortality among patients with atrial fibrillation undergoing percutaneous coronary intervention

• Published in: Catheterization and cardiovascular interventions Vol. 98; no. 5; pp. 838 - 845
• Main Authors: Asif, Anum, Sezer, Ahmet, Thoma, Floyd, Toma, Catalin, Schindler, John, Fowler, Jeffrey, Smith, Conrad, Marroquin, Oscar C., Mulukutla, Suresh R.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2021; Wiley Subscription Services, Inc
• Subjects: Angioplasty; Antiplatelet therapy; Bleeding; bleeding complications; Cardiac arrhythmia; coronary artery disease; Fibrillation; Hospitalization; hospitalizations; Implants; Mortality; Patients; percutaneous coronary intervention; Stents
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29399

Background The predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy, PRECISE‐DAPT (P‐DAPT) score has been validated in large cohorts as an effective tool in predicting bleeding complication after dual antiplatelet therapy (DAPT) as well as in predicting in‐hospital mortality. The implication of using this score to predict outcomes, including mortality in patients with atrial fibrillation (AF) undergoing PCI is unknown. Objective Role of P‐DAPT score to study clinical outcomes, including mortality, hospitalization, and major bleeding, particularly among patients with AF. Methods This is a retrospective observational study of 18,850 consecutive patients who underwent percutaneous coronary intervention (PCI) across a large multihospital healthcare system from 2010 to 2019. Patients were stratified into four groups depending on the presence or absence of AF and P‐DAPT score, with score ≥ 25 defined as high risk. The primary outcome was all‐cause mortality. The secondary outcomes evaluated were hospitalization and major bleeding. Results In the unadjusted analyses, a P‐DAPT score ≥ 25, in both AF and non‐AF population, was associated with increased mortality, hospitalization, and bleeding. After adjusting for baseline covariates, no significant differences in major bleeding risk were found across the four groups. However, a P‐DAPT score of ≥25 in AF patients was associated with a higher risk for hospitalizations related to cardiovascular causes (HR: 2.15 95% CI 2.00–2.3, p < .0001). Among AF patients, P‐DAPT score ≥ 25 was found to be strongly associated with mortality (HR 3.5; 95% CI 2.95–4.25, p < .0001) as compared with AF patients with score < 25 (HR 1.18, 95% CI 0.88–1.54, p = .26). Conclusion In this large cohort of patients undergoing PCI, the P‐DAPT score can help to identify patients at high risk for long‐term mortality, particularly among those with atrial fibrillation.