Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients

Abu‐Assi, Emad; Raposeiras‐Roubín, Sergio; Paz, Rafael Cobas; Caneiro‐Queija, Berenice; Martínez-Reglero, Cristina; Rodríguez-Rodríguez, José Manuel; Baz, A H El; Íñiguez‐Romo, Andrés

doi:10.4244/eij-d-17-00550

Cited by 44 publications

(24 citation statements)

References 19 publications

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“…17 The rate of anaemia was 16% in the Cardiología del Complejo Hospitalario Universitario de VIgo (CardioCHUVI) PCI registry, while its prevalence in our study was 32.3%. 18 Moreover, anaemia was significantly more common in the female patients in our study than in the male patients. The particular presence of anaemia among the female patients may explain the high PRECISE-DAPT scores observed in these patients in the present study.…”

Section: Discussionmentioning

confidence: 45%

Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study

Avcı

Kırış

Akgün

et al. 2020

Eur J Clin Investigation

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Objective: Bleeding is one of the most important causes of mortality in patients with acute coronary syndrome (ACS). This study therefore aimed to investigate bleeding risk in patients with ACS who were scheduled to receive dual antiplatelet therapy (DAPT) in Turkey. Methods: This was a multicentre, observational, cross-sectional cohort study. The study population included 963 patients with ACS from 12 centres in Turkey. We used the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score to predict the bleeding risk for all the patients. The patients were divided into high (≥25) or low (˂25) bleeding risk groups based on their PRECISE-DAPT scores. Results: The mean PRECISE-DAPT score was 21.9. Overall, 32.2% of the patients had high PRECISE-DAPT scores (≥25). Compared with the male patients, the female patients had higher PRECISE-DAPT scores (28.2 ± 15.7 vs 18.4 ± 13.6, P ˂ .001). Among the females, the rate of patients with a PRECISE-DAPT score ≥25 was 53%, while among the male patients, the score occurred at a rate of 22%. The female patients had lower haemoglobin (Hb) levels than the male patients (12.1 ± 1.7 vs 13.8 ± 1.9, P ˂ .001) and lower creatinine clearance (70.7 ± 27.5 vs 88.7 ± 26.3, P ˂ .001). The in-hospital bleeding rates were higher among the patients with high PRECISE-DAPT scores than among those who did not have high scores. Furthermore, the patients with high PRECISE-DAPT scores had a higher in-hospital mortality rate compared with those with low PRECISE-DAPT scores (1% vs 0%, P = .11). Conclusions: The mean PRECISE-DAPT score was high among the patients with ACS in this study, indicating that the bleeding tendency was high. This study showed 2 of 11 | AVCI et Al. How to cite this article: Avci E, Kiriş T, Akgün DE, et al. Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study.

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Section: Discussionmentioning

confidence: 45%

Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study

Avcı

Kırış

Akgün

et al. 2020

Eur J Clin Investigation

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“…In the Spanish CardioCHUVI (Cardiologia del Complejo Hospitalario Universitario de Vigo) cohort (n=1,926),PARIS bleeding score and PRECISE-DAPT score were retrospectively validated. 54 For major bleedings, PARIS and PRECISE-DAPT showed a moderate discriminative power and, using decision curve analyses, it was concluded that the PARIS bleeding score had a superior performance. Recently, the DAPT score was successfully validated in a pooled Japanese cohort (n=12,223).…”

Section: Patient-tailored Duration Of Dual Antiplatelet Therapymentioning

confidence: 99%

Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Is Less More?

Rozemeijer¹

2018

US Cardiology Review

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The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) using the latest-generation drug-eluting stents remains a matter of debate. Evidence suggests short regimens of DAPT are favorable for patients with a low ischemic risk, while those at a high risk of ischemia may benefit from taking DAPT for a long duration. An individually assessed risk profile is pivotal in guiding DAPT duration. Risk scores may aid individual patient DAPT decisions, but the value they add to clinical outcomes still needs to be established in a prospective randomized trial. This review aims to provide an overview on DAPT, evaluate the available evidence on DAPT duration with a description of common pitfalls of trial interpretation, and assess available tools for individual risk assessment in patients scheduled for PCI with the latest-generation DES.

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“…Notably, these high-risk features are well recognized to predispose to higher rates of thrombotic events [20][21][22], but they were the exclusion criteria in a retrospective analysis using the pooled patient-level data of 6 randomized controlled trials [7]. Validation of the PARIS bleeding score and instruction for its calculation were described elsewhere [16,18,23]. Patients were deemed at HBR for scores ≥8 and non-HBR for scores <8. e primary ischemic outcome was MACE, defined as a composite of cardiac death, MI, definite or probable ST, and target lesion revascularization (TLR).…”

Section: Definitions and Clinical Outcomesmentioning

confidence: 99%

Percutaneous Coronary Intervention Complexity and Risk of Adverse Events in Relation to High Bleeding Risk Among Patients Receiving Drug-Eluting Stents: Insights From a Large Single-Center Cohort Study

Wang

Dou

2020

Journal of the American College of Cardiology

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Background/Aim. e relation between complex percutaneous coronary intervention (PCI), high bleeding risk (HBR), and adverse events after coronary artery implantation of drug-eluting stents has been incompletely characterized. is study sought to investigate the ischemic and bleeding events after complex PCI including stratification according to HBR estimated by PARIS bleeding risk score. Methods. Between January 2013 and December 2013, 10,167 consecutive patients undergoing PCI were prospectively enrolled in Fuwai PCI Registry. Complex PCI was defined when having at least one of the following characteristics: 3 vessels treated, ≥3 stents implanted, ≥3 lesions treated, bifurcation with 2 stents implanted, total stent length >60 mm, treatment of chronic total occlusion, unprotected left main PCI, in-stent restenosis target lesion, and severely calcified lesion. e primary ischemic endpoint was major adverse cardiovascular events (MACE) (composite of cardiac death, myocardial infarction, definite/ probable stent thrombosis, and target lesion revascularization), and primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. Results. e median duration of follow-up was 29 months. In adjusted Cox regression analysis, patients having complex PCI procedures experienced higher risks of MACE (hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.38-1.92; P < 0.001), compared with noncomplex PCI. In contrast, the risk of clinically relevant bleeding was statistically similar between the 2 groups (HR: 0.86 [0.66-1.11]; P � 0.238). ere was no statistical interaction between HBR (PARIS bleeding score ≥8 or <8) and complex PCI in regard to MACE (adjusted P interaction � 0.388) and clinically relevant bleeding (adjusted P interaction � 0.279). Conclusions. Patients who had undergone complex PCI resulted in substantially more ischemic events, without an increase in clinically relevant bleeding risk, and these associations did not seem to be modified by HBR status. More intensified antiplatelet therapy may be beneficial for patients with complex percutaneous coronary revascularization procedures.

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Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients

Cited by 44 publications

References 19 publications

Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study

Bleeding risk in patients with acute coronary syndrome in a Turkish population: Results from the Turkish Acute Coronary Syndrome Registry (TACSER) study

Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Is Less More?

Percutaneous Coronary Intervention Complexity and Risk of Adverse Events in Relation to High Bleeding Risk Among Patients Receiving Drug-Eluting Stents: Insights From a Large Single-Center Cohort Study

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