External validity of the PRECISE-DAPT score in patients undergoing PCI: a systematic review and meta-analysis

Abstract

Aims To summarize the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets. Methods and results We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratios (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of 21 studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high bleeding risk (PRECISE-DAPT score ≥25), and when compared to those at low bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24–3.29; P-value <0.001) and major bleedings (OR: 3.51; 95% CI: 2.71–4.55; P-value <0.001). Pooling data on c-stat whenever available, the PRECISE-DAPT score showed a moderate discriminative power in predicting major bleeding events at 1 year (pooled c-stat: 0.71; 95% CI: 0.64–0.77). Conclusion This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.

Individualization of Duration of Dual Antiplatelet Therapy after Coronary Stenting: A Comprehensive, Evidence-Based Review

“…In patients identified at high risk (score ≥ 25), a longer DAPT duration significantly increased bleeding, but not in those with lower risk profiles [92]. Multiple external validations of this prediction tool have been presented, largely confirming the score discriminative ability [93,94].…”

Demystifying the Contemporary Role of 12-Month Dual Antiplatelet Therapy After Acute Coronary Syndrome

“…35 The score has been so far externally validated in a total of 21 studies and 67 283 patients, with consistent moderate discriminative ability for 1-year major bleeding events (pooled c-stat, 0.71 [95% CI, 0.64-0.77]). 36 In a pooled dataset from 5 DAPT-duration randomized trials, a longer DAPT duration (≥12 months) significantly increased bleeding in high-risk patients (score ≥25), but not in those at lower risk profiles (P for interac-tion=0.007) and provided a significant ischemic benefit only in this latter group. 35 These findings suggest that a prolonged DAPT regimen in patients selected exclusively for low out-of-hospital bleeding risk might minimize risks and maximize benefits.…”

Antithrombotic Therapy Optimization in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

“…The PRECISE-DAPT score was originally developed and validated for predicting bleeding in DAPT-treated PCI patients. Importantly, secondary validation analyses evaluated the score’s performance in patients receiving other antithrombotic regimens [ 44 , 45 ], including AF-PCI patients on long-term OAC. A sub-analysis of the RE-DUAL PCI trial examined the impact of bleeding risk based on the PRECISE-DAPT score on decision-making regarding DAT versus TAT [ 30 ].…”