Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome

Abstract

The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ≥25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT <25 and PC ≥150 × 109/L, the adjusted HR was 7.2 (95% CI 2.4-21.6) for those with PRECISE-DAPT <25 and PC <150 × 109/L; 10.7 (95% CI: 5.2-21.9) for those with PRECISE-DAPT ≥25 and PC ≥150 × 109/L; and 17.9 (95% CI 7.0-45.4) for those with PRECISE-DAPT ≥25 and PC <150 × 109/L. Selecting thresholds for high-risk designation, the PRECISE-DAPT score integrated with PC had a higher prediction value, compared to the PRECISE-DAPT and Global Registry of Acute Coronary Events scores.

Relationship between predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE‐DAPT) score and mortality among patients with atrial fibrillation undergoing percutaneous coronary intervention

“…A study by Morici used P-DAPT score and platelet count on admission and found that the score ≥ 25 to be an independent predictor of mortality in patients with ACS undergoing PCI. 20 However, this study lacks data on AF patients. Iwasaki reported an association of P-DAPT score ≥ 25 with major adverse cardiac events (MACE) in patients with AF undergoing PCI.…”

“…In the past, various efforts have been made to predict mortality in patients undergoing PCI. A study by Morici used P‐DAPT score and platelet count on admission and found that the score ≥ 25 to be an independent predictor of mortality in patients with ACS undergoing PCI 20 . However, this study lacks data on AF patients.…”

A Novel Multiple Risk Score Model for Prediction of Long-Term Ischemic Risk in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: Insights From the I-LOVE-IT 2 Trial

“…However, to our knowledge, there was not a robust, interoperable, and universal risk score that could be extended to different populations, which is mainly caused by prediction algorithms derived from different cohorts and a complex and time-varying clinical process ( 8 – 11 ). Meanwhile, previous studies demonstrate that an additive value of one risk score combined with a biomarker, angiographic characteristic, and with another risk score to risk predicting ( 12 – 14 ).…”

Long-Term Risk of Major Adverse Cardiovascular Events in Patients With Acute Coronary Syndrome: Prognostic Role of Complete Blood Cell Count

“…20,21 Thrombocytopenia has been associated with bleeding events and increased mortality, whereas thrombocytosis has been associated with increased thrombotic events and overall mortality. [4][5][6]13,20 Two prior observational studies 22,23 have explored the significance of the CBC as a whole, assessed either during baseline hospitalization 22 or upon hospital admission, 23 in patients with CAD (both stable and unstable) and found it to be a better predictor of an increased risk for all-cause mortality and MACE, compared to traditional stratification tools.…”

“…4,6 Accordingly, Hb levels, white blood cell (WBC), and platelet count (PC) have been separately associated with worse prognosis in patients with ACS, and all of these parameters have been included in postdischarge stratification tools in this setting. [10][11][12][13][14][15][16][17][18][19][20][21][22][23] However, no study has specifically explored the role of WBC count, Hb, and PC parameters, grouped together as single predictor, and taken on admission (WBC) and at discharge (Hb, PC), respectively, on ischemic and bleeding events in the patients with ACS.…”