The PRECISE-DAPT score and 5-year outcomes after percutaneous coronary intervention: a large-scale, real-world study from China

Abstract

Aims The PRECISE-DAPT score is recommended by guidelines for predicting out-of-hospital bleeding in patients after percutaneous coronary intervention (PCI). However, the long-term prognostic value of the PRECISE-DAPT score in patients after PCI remains unclear. Methods and Results We performed a prospective study of 10,724 patients who underwent PCI throughout 2013 in Fuwai hospital. The bleeding endpoint was Bleeding Academic Research Consortium 2, 3, or 5 bleeding. The ischaemic endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). After a 5-year follow-up, 10,109 patients were finally analysed. A total of 415 (4.11%) patients experienced bleeding, 364 (3.60%) experienced all-cause death, and 2049 (20.27%) had MACCE. Using Cox regression, the risk of bleeding (hazard ratio [HR]: 1.721, 95% confidence interval [CI]: 1.180–2.511, P = 0.005), MACCE (HR: 1.607, 95% CI: 1.347–1.917, P < 0.001), and all-cause-death (HR: 3.902, 95% CI: 2.916–5.221, P < 0.001) in patients with a high score were significantly higher than those in patients with a low score. The PRECISE-DAPT score showed prognostic value for 5-year events of bleeding (C statistic: 0.566, 95% CI: 0.537–0.594), MACCE (C statistic: 0.540, 95% CI: 0.527–0.553), and all-cause-death (C statistic: 0.673, 95% CI: 0.644–0.702). Conclusion After 5 years of follow-up, the PRECISE-DAPT score has a statistically significant predictive value for long-term bleeding events in Chinese PCI population, and also had some prognostic value for death and MACCE.

New Insights Into Long- Versus Short-Term Dual Antiplatelet Therapy Duration in Patients After Stenting for Left Main Coronary Artery Disease: Findings From a Prospective Observational Study

“…29 It should be interpreted in light of the reduced frequencies of age≥75 years (8.3% versus 38.0%), long-term use of oral anticoagulation (0.7% versus 8.7%), moderate or severe anemia (12.3% versus 50.2%), malignancy (2.4% versus 8.7%), chronic kidney disease (18.0% versus 34.2%; severe/end-stage chronic kidney disease: 0.2% versus 11.0%), and transfemoral access (24.4% versus 92.6%) in our study compared with those in the Mount Sinai registry. Although HBR rate would seem low, our results were in keeping with prior findings validating the ARC-HBR definition 30,31 (XIENCE V China registry: <22.0%; I-LOVE-IT 2 trial: 16.0%) and PRECISE-DAPT score 32,33 (2 observational registries: 4.4% and 9.7%) in China. Another reason for the discrepancy in safety of prolonged DAPT could be that clopidogrel was the predominant P2Y 12 inhibitor in the patients in the study, whereas only 8% of patients were treated with ticagrelor plus aspirin at discharge.…”

The Clinical Value of the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy Score in Predicting Long-Term Major Adverse Cardiovascular And Cerebrovascular Events and Major Bleeding in Acute Coronary Syndrome Patients Who Underwent Percutaneous Coronary Intervention

“…It has been shown that PRECISE-DAPT score had a predictive value for 5-year bleeding, mortality, and MACCE. 11 Similarly, this score was predictive of both bleeding and MACCE in the present study. Also, a high score was an independent predictor of all-cause mortality at long-term follow-up in our study.…”

“…10 There are limited data showing the association of PRECISE-DAPT scores with long-term mortality. 11 In our study, we aimed to evaluate the value of this scoring in terms of major bleeding, cardiovascular outcomes, and mortality during long-term follow-up.…”

Antiplatelet Therapy Aims and Strategies in Asian Patients with Acute Coronary Syndrome or Stable Coronary Artery Disease

“…As researchers realize the core importance of balancing between ischemic and bleeding risks in APT, more studies are addressing patients who fall into the "high bleeding risk" (HBR) category. Tools such as the PRECISE-DAPT score [59] (>25 points) and Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria [60] (one major or two minor criteria) have also been developed for identifying HBR patients.…”

“…The DAPT score successfully stratified ischemic and bleeding risks in a pooled cohort of 12,223 Japanese patients [77]; however, the authors noted that ischemic event rates were low, even in patients with high DAPT scores. To evaluate bleeding risks, the PRECISE-DAPT score provides a standardized tool to predict out-of-hospital bleeding and has been validated in both Chinese and Korean populations [59,78]. Developed from the records of 32,057 patients from Hong Kong, the CARDIAC score [79] helps to predict the risk of major bleeding within 1 year after PCI, based on anticoagulation therapy, age, renal insufficiency, drop in hemoglobin levels, and baseline anemia.…”