Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI

• Published in: International journal of cardiology. Heart & vasculature Vol. 33; p. 100750
• Main Authors: Dannenberg, Lisa, Afzal, Shazia, Czychy, Natalia, M'Pembele, René, Zako, Saif, Helten, Carolin, Mourikis, Philipp, Zikeli, Dorothee, Ahlbrecht, Samantha, Trojovsky, Kajetan, Benkhoff, Marcel, Barcik, Maike, Wolff, Georg, Zeus, Tobias, Kelm, Malte, Polzin, Amin
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2021; Elsevier
• Subjects: Bleeding; DAPT; MACCE; Original Paper; Scores; TIMI; AF; ROC; Scores; MACCE; PARIS; TIA; Bleeding; PD; TIMI; GRACE; PCI; STEMI; DAPT; MACCE, Major adverse cardiac and cerebrovascular events; PCI, percutaneous coronary intervention; DAPT, Dual antiplatelet medication; AF, Atrial fibrillation; STEMI, ST-elevation myocardial infarction; TIMI, Thrombolysis in myocardial infarction; PARIS, Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients; PD, PRECISE-DAPT, PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy; ROC, Receiver operating characteristic; GRACE, Global Registry of Acute Coronary Events; TIA, Transient ischemic attack
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2021.100750

Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. 524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01–8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36–9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52–2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12–5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26–3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden’s index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24). In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events.