Comparative Assessment of Predictive Performance of PRECISE-DAPT, CRUSADE, and ACUITY Scores in Risk Stratifying 30-Day Bleeding Events

Abstract

<jats:title>Abstract</jats:title><jats:p> Background The utility of the PRECISE-DAPT score in predicting short-term major bleeding, either alone, or in comparison with the CRUSADE and ACUITY scores, has not been investigated. This analysis compared the predictive performances of the three bleeding scores in stratifying the risk of 30-day major bleeding postpercutaneous coronary intervention in patients with dual-antiplatelet therapy.</jats:p><jats:p> Methods In this post hoc subanalysis of the GLOBAL LEADERS trial, the primary safety objective (bleeding according to the Bleeding Academic Research Consortium [BARC] criteria [type 3 or 5]) was assessed at 30 days according to the three scores in the overall population, and in patients with acute (ACS) and chronic coronary syndrome (CCS).</jats:p><jats:p> Results In a total of 15,968 patients, we calculated all three scores in 14,709 (92.1%). Irrespective of clinical presentation, the PRECISE-DAPT (c-statistics: 0.648, 0.653, and 0.641, respectively), CRUSADE (c-statistics: 0.641, 0.639, and 0.644, respectively), and ACUITY (c-statistics: 0.633, 0.638, and 0.623, respectively) scores were no significant between-score differences in discriminatory performance for BARC 3 or 5 bleeding up to 30 days, and similarly the PRECISE-DAPT score had a comparable discriminative capacity according to the integrated discrimination improvement when compared with the other scores. In ACS, the CRUSADE score had a poor calibration ability (Hosmer–Lemeshow goodness-of-fit [GOF] chi-square = 15.561, p = 0.049), whereas in CCS, the PRECISE-DAPT score had poor calibration (GOF chi-square = 15.758, p = 0.046).</jats:p><jats:p> Conclusion The PRECISE-DAPT score might be clinically useful in the overall population and ACS patients for the prediction of short-term major bleeding considering its discriminative and calibration abilities.</jats:p>

Impact of proton pump inhibitors on efficacy of antiplatelet strategies with ticagrelor or aspirin after percutaneous coronary intervention: Insights from the GLOBAL LEADERS trial

“…Our study therefore could support the safety of PPI use in patients with ticagrelor monotherapy up to 2 years or DAPT up to 1 year after PCI. 10 Our analyses highlight that in the contemporary PCI cohort, the prescription rate of PPIs is nearly 50% despite patient's having a relatively low bleeding risk (e.g., mean PRECISE-DAPT score was 16.4 ± 8.8, 26 and <1.0% of patients had a history of previous severe bleeding). In addition, the prescription rates were almost consistent throughout the follow-up regardless of cessation of DAPT.…”

External Validation of the ACUITY/HORIZON Bleeding Risk Score among Acute Coronary Syndrome Patients in Thai PCI Registry

“…The discriminatory capacity of the ACUITY/HORIZON score has already been validated in several ACS populations, with acceptable C-statistic of 0.63 to 0.73 regarding different definitions of in-hospital major bleeding. 3 4 5 6 7 8 9…”

“…The discriminatory capacity of the ACUITY/HORIZON score has already been validated in several ACS populations, with acceptable C-statistic of 0.63 to 0.73 regarding different definitions of in-hospital major bleeding. [3][4][5][6][7][8][9] The main strength of this Asian study is the prospective collection of data to represent a complete and unselected group of ACS patients in a contemporary real-world setting. Of importance, all the variables included in the update model are readily available to the interventional team, enabling the preprocedural identification of patients.…”

“…They have been externally validated for assessing the bleeding risk in ACS patients in other settings. [3][4][5][6][7][8][9] However, contemporary interventional practices and antithrombotic treatments, may modify the predictive value of risk scores. Directly applying these bleeding prediction models may over or under estimate the bleeding risk.…”

Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy

“…In patients with ACS, numerous bleeding risk-stratification scores have been developed with differing advantages or disadvantages [ 4 , 5 ]. Although the age, creatinine, and ejection fraction (ACEF) score was first developed to predict mortality in elective coronary artery bypass graft (CABG) operations [ 6 ], whether it could be a predictor of bleeding events in conservatively treated patients has also been discussed in the literature [ 7 ].…”