The association of PRECISE-DAPT score with ischaemic outcomes in patients taking dual antiplatelet therapy following percutaneous coronary intervention: a meta-analysis

Abstract

Aims The PRECISE-DAPT score identifies patients at high risk of bleeding complications following percutaneous coronary intervention (PCI). International guidelines recommend the PRECISE-DAPT to identify patients at high risk for bleeding, who may benefit from shortened dual antiplatelet therapy (DAPT). The association of the PRECISE-DAPT score to ischemic outcomes remains unclear. We performed a meta-analysis investigating the association between a high PRECISE-DAPT score and ischemic outcomes. Methods and Results A comprehensive literature search was conducted on articles published between March 11, 2017 and June 5, 2021. Two reviewers independently screened articles for inclusion using pre-defined criteria. Outcome measures extracted included: composite ischemic events, major bleeding events and all-cause mortality. A random effects model was applied to obtain combined risk estimates for outcomes. From 12 included studies, there were 39459 patients with PRECISE-DAPT <25 and 14761 patients with PRECISE-DAPT ≥ 25. PRECISE-DAPT score ≥ 25 was associated with increased risk of composite ischemic events [OR 2.16; 95% CI 1.77-2.65], myocardial infarction [OR 2.06; 95% CI 1.38-3.08] and ischemic stroke [OR 2.90; 95% CI 1.76-4.78]. Patients with a PRECISE-DAPT score ≥ 25 had increased risk of major bleeding [OR 3.62; 95% CI 2.62-4.99]. Patients with a PRECISE-DAPT score ≥ 25 had higher risk of all-cause mortality [OR 5.83; 95% CI 5.37-6.33]. Conclusion Patients with a PRECISE-DAPT score ≥ 25 are at increased risk for ischemic events, bleeding, and all-cause mortality. Prospective evaluation of a PRECISE-DAPT guided antiplatelet therapy approach is required to demonstrate benefit in this high-risk population.

Management of Residual Risk in Chronic Coronary Syndromes. Clinical Pathways for a Quality-Based Secondary Prevention

“…Furthermore, when patients with a history of bleeding are excluded, an increased number of CV risk factors is linked with a significant More recently, the Predicting Bleeding Complication in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, specifically designed for the prediction of bleeding, was introduced [40]. A recent meta-analysis involving over 50,000 patients established that a PRECISE DAPT score > 25 was linked to an increased likelihood of major bleeding and an elevated risk of MACE [41].…”

Avaliação da duração e do risco de sangramento entre diferentes estratégias de dupla antiagregação plaquetária administradas após a intervenção coronária percutânea: uma revisão de escopo

“…Devido a possibilidade de falha à medida que existe a necessidade de individualização da dupla terapia antiplaquetária, novas abordagens relacionadas ao escore TDAP foram criadas, sobretudo na tentativa de aumentar a acurácia de predição entre eventos isquêmicos e hemorrágicos (Costa, et al, 2020). O escore PRECISE -TDAP, uma abreviação de ''prevendo complicações hemorrágicas em pacientes submetidos a implantação de stent e terapia antiplaquetária dupla subsequente'', se revelou útil nesse sentido, uma vez que valores ≥ 25 pontos (também válidos para o critério ARC-HBR) sugerem uma maior chance de risco para isquemia, hemorragia e mortalidade por todas as causas em geral (Clifford, et al, 2022;Zhong, et al, 2021).…”

“…Ainda assim, o escore PRECISE-TDAP apresenta o melhor desempenho que o risco de sangramento categorizado através da estratégia PARIS (0,653 vs. 0,593; p = 0,01) (Bianco, et al, 2020). Assim, as recomendações científicas mais atuais sugerem que o uso do PRECISE-TDAP seja destinado para a estratificação do risco de sangramento maior em pacientes que fazem uso de aspirina associada ao prasugrel ou ticagrelor, enquanto que o escore PARIS possui finalidade complementar, sendo útil para a predição do risco isquêmico (Clifford, et al, 2022).…”

Recent Evidence on Advances in PCI Treatment for Left Main Coronary Artery Disease

“…Results of an observational study including 1827 patients who received PCI with DES for LMCAD from two large multicenter registries IRIS-MAIN and KOMATE (Korean Multicenter Angioplasty Team Study) [ 53 ] revealed that DAPT 12 months was in relation to significantly higher risk of MACCE while not associated with evidently reduced bleeding, compared to DAPT for 12–24 months. The DAPT score and PRECISE-DAPT (PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy) score designed to evaluate the benefits and risks of different DAPT durations [ 52 , 54 ] can be used to identify patients with high risk of bleeding and guide individual DAPT duration strategy.…”