Performance of PRECISE-DAPT Score for Predicting Bleeding Complication During Dual Antiplatelet Therapy

Abstract

Background: Dual antiplatelet therapy (DAPT) helps prevent ischemic events after coronary stenting but comes with an increased risk of bleeding. Several risk scores have been proposed for the management of patients receiving DAPT, but no standardized tool exists for the purpose. We sought to compare the performance of the new PRECISE-DAPT (Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy), CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines), and ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) scores for the prediction of bleeding in Korean patients receiving DAPT. Methods and Results: Nine hundred and four consecutive patients who underwent stent implantation received DAPT. One-year bleedings were assessed using TIMI (Thrombolysis in Myocardial Infarction), GUSTO (Global Use of Strategies to Open Occluded Arteries), and BARC (Bleeding Academic Research Consortium). Bleeding events occurred in 154 patients (17.0%) by BARC type ≥3a criteria, 119 patients (13.2%) by the TIMI minor or major criteria, and 80 patients (8.8%) by the GUSTO moderate or severe criteria. In the C statistic analysis, CRUSADE, ACUITY, and PRECISE-DAPT scores showed high area under the curve values for 1-year bleeding (area under the curve 0.73, 0.75, and 0.75 for TIMI minor or major bleeding; area under the curve 0.81, 0.79, and 0.82 for GUSTO moderate to severe; and area under the curve 0.79, 0.81, and 0.81 for BARC type ≥3a, respectively). The discriminate ability of PRECISE-DAPT was similar to CRUSADE and ACUITY in bleeding complications. However, the PRECISE-DAPT score was better at reclassifying the risk of 1-year bleeding compared with ACUITY for the 3 bleeding criteria. Conclusions: The PRECISE-DAPT score is a simple 5-item risk score that represents a standardized tool for the prediction of 1-year bleeding in Korean patients receiving DAPT, regardless of bleeding definition.

Comparison of Performance between ARC-HBR Criteria and PRECISE-DAPT Score in Patients Undergoing Percutaneous Coronary Intervention

“…The 2017 European Society of Cardiology Focused Update on DAPT recommended the PRECISE-DAPT score for guidance over the duration of DAPT [22]. In the previous study, we validated the performance of this score for predicting bleeding events in Korean patients undergoing PCI [23]. The simplified PRECISE-DAPT score without WBC count has a similar predictive value for bleeding after PCI [24].…”

Contribution of ESC DAPT guideline-endorsed high thrombotic risk features to long-term clinical outcomes among patients with and without high bleeding risk after PCI

“…It should also be mentioned that high as many as 20% of our patients had undergone a PCI with total stent length > 60 mm (of note, the proportion of patients with long stent stenting in Bern PCI registry was 6.5%). Third, there is evidence demonstrating an increased risk of bleeding events in patients with baseline higher categories of bleeding risk prediction scores [32,33]. Lower bleeding risk of our study patients, compared with Bern PCI registry (PRECISE-DAPT score: 10.6 ± 8.5 vs. 20.6 ± 13.3), may have partly explain difference in the risk of clinically relevant bleeding.…”

Pharmacodynamics and Outcomes of a De-Escalation Strategy with Half-Dose Prasugrel or Ticagrelor in East Asians Patients with Acute Coronary Syndrome: Results from HOPE-TAILOR Trial

“…Bleeding events related to potent P2Y12 inhibitors [ 7 , 8 ], or triple therapy (DAPT plus oral anticoagulant) [ 25 ], or high bleeding risk (HBR) [ 26 , 27 ], have resulted in adverse outcomes. Previously we reported that the PRECISE-DAPT Score was validated to predict bleeding events in Korean patients taking DAPT after PCI [ 11 ]. Additionally, these bleeding events occurred more frequently in the first month after PCI resulting in a hazard ratio of 4.0 (bleedings vs. MACE) [ 28 ].…”

“…After acute or subacute stages of PCI in ACS patients, bleeding events are more problematic during the maintenance dose periods [ 11 ]. The recent TICO and TWILIGHT studies demonstrated that de-escalation by dropping aspirin at 3 months resulted in favorable outcomes [ 12 , 13 ].…”