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Validation of the 4-item PRECISE-DAPT score : A SWEDEHEART study

Wester, Axel LU ; Mohammad, Moman A. LU ; Olivecrona, Göran LU ; Holmqvist, Jasminka ; Yndigegn, Troels LU and Koul, Sasha LU (2021) In Journal of the American Heart Association 10(20).
Abstract

BACKGROUND: The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been shown to predict out-of-hospital major bleeding after myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy (DAPT). However, large validation studies have been scarce and the discriminative ability for patients with a preexisting bleeding risk factor (elderly, underweight, women, anemia, kidney dysfunction, or cancer) in a real-world setting is unknown. METHODS AND RESULTS: Patients undergoing percutaneous coronary intervention for myocardial infarction between 2008 and 2017 were included from the SWEDEHEART (Swedish Web System for... (More)

BACKGROUND: The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been shown to predict out-of-hospital major bleeding after myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy (DAPT). However, large validation studies have been scarce and the discriminative ability for patients with a preexisting bleeding risk factor (elderly, underweight, women, anemia, kidney dysfunction, or cancer) in a real-world setting is unknown. METHODS AND RESULTS: Patients undergoing percutaneous coronary intervention for myocardial infarction between 2008 and 2017 were included from the SWEDEHEART (Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry (n=66 295). The predictive value of the PRECISE-DAPT score for rehospitalization with major bleeding during dual antiplatelet therapy was evaluated using receiver operating char-acteristic analyses. A high PRECISE-DAPT score (≥25; n=13 894) was associated with increased risk of major bleeding (3.9% versus 1.8%; hazard ratio [HR], 2.2; 95% CI, 2.0– 2.5; P<0.001) compared with a non-high score (<25; n=52 401). The score demonstrated a c-statistic of 0.64 (95% CI, 0.63– 0.66). The discriminative ability of the score to further stratify bleeding risk in patients with preexisting bleeding risk factors was poor, especially in patients who are elderly (c-statistic=0.57; 95% CI, 0.55– 0.60) or underweight (c-statistic=0.56; 95% CI, 0.51– 0.61), for whom a non-high PRECISE-DAPT score was associated with similar bleeding risk as a high PRECISE-DAPT score in the general myocardial infarction population. CONCLUSIONS: In this nationwide population-based study, the PRECISE-DAPT score performed moderately in the general my-ocardial infarction population and poorly in patients with preexisting bleeding risk factors, where its usefulness seems limited.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Bleeding, Dual antiplatelet therapy, Myocardial infarction, PRECISE-DAPT, SWEDEHEART
in
Journal of the American Heart Association
volume
10
issue
20
article number
e020974
publisher
Wiley-Blackwell
external identifiers
  • pmid:34612051
  • scopus:85119303722
ISSN
2047-9980
DOI
10.1161/JAHA.121.020974
language
English
LU publication?
yes
id
0531e923-8d0f-4e80-ad85-12a16f2cbbf5
date added to LUP
2021-12-03 13:26:59
date last changed
2024-06-29 23:07:30
@article{0531e923-8d0f-4e80-ad85-12a16f2cbbf5,
  abstract     = {{<p>BACKGROUND: The Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been shown to predict out-of-hospital major bleeding after myocardial infarction treated with percutaneous coronary intervention and dual antiplatelet therapy (DAPT). However, large validation studies have been scarce and the discriminative ability for patients with a preexisting bleeding risk factor (elderly, underweight, women, anemia, kidney dysfunction, or cancer) in a real-world setting is unknown. METHODS AND RESULTS: Patients undergoing percutaneous coronary intervention for myocardial infarction between 2008 and 2017 were included from the SWEDEHEART (Swedish Web System for Enhancement of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry (n=66 295). The predictive value of the PRECISE-DAPT score for rehospitalization with major bleeding during dual antiplatelet therapy was evaluated using receiver operating char-acteristic analyses. A high PRECISE-DAPT score (≥25; n=13 894) was associated with increased risk of major bleeding (3.9% versus 1.8%; hazard ratio [HR], 2.2; 95% CI, 2.0– 2.5; P&lt;0.001) compared with a non-high score (&lt;25; n=52 401). The score demonstrated a c-statistic of 0.64 (95% CI, 0.63– 0.66). The discriminative ability of the score to further stratify bleeding risk in patients with preexisting bleeding risk factors was poor, especially in patients who are elderly (c-statistic=0.57; 95% CI, 0.55– 0.60) or underweight (c-statistic=0.56; 95% CI, 0.51– 0.61), for whom a non-high PRECISE-DAPT score was associated with similar bleeding risk as a high PRECISE-DAPT score in the general myocardial infarction population. CONCLUSIONS: In this nationwide population-based study, the PRECISE-DAPT score performed moderately in the general my-ocardial infarction population and poorly in patients with preexisting bleeding risk factors, where its usefulness seems limited.</p>}},
  author       = {{Wester, Axel and Mohammad, Moman A. and Olivecrona, Göran and Holmqvist, Jasminka and Yndigegn, Troels and Koul, Sasha}},
  issn         = {{2047-9980}},
  keywords     = {{Bleeding; Dual antiplatelet therapy; Myocardial infarction; PRECISE-DAPT; SWEDEHEART}},
  language     = {{eng}},
  number       = {{20}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Validation of the 4-item PRECISE-DAPT score : A SWEDEHEART study}},
  url          = {{http://dx.doi.org/10.1161/JAHA.121.020974}},
  doi          = {{10.1161/JAHA.121.020974}},
  volume       = {{10}},
  year         = {{2021}},
}