Key result
PRECISE-DAPT score predicts mid-term ACS mortality, performing best in STEMI with ~0.84 AUC.
Why the study?
While the PRECISE-DAPT score predicts bleeding risk after PCI, the authors sought to validate it as a mid-term all-cause mortality predictor in acute coronary syndrome.
Does the PRECISE-DAPT score predict mid-term all-cause mortality in patients with acute coronary syndrome?
Observational (n=3,127)
No
Does the PRECISE-DAPT score predict mid-term all-cause mortality in patients with acute coronary syndrome?
Effect estimate: AUC 0.843 (95% CI 0.820-0.865)
The PRECISE-DAPT score, originally designed for bleeding risk, can also effectively predict mid-term all-cause mortality in ACS patients, especially those with STEMI.
Supports extending PRECISE-DAPT to mortality prediction in ACS; leaves open clinical adoption pending prospective validation.
Background The PRECISE-DAPT score is a useful tool for predicting the risk of bleeding complications after percutaneous coronary intervention (PCI) requiring dual antiplatelet therapy. However, PRECISE-DAPT may be used as an all-cause mortality predictor in acute coronary syndrome (ACS). Purpose We aimed to validate the PRECISE-DAPT score as a mid-term mortality predictor in acute coronary syndrome. Methods All acute coronary syndrome patients hospitalized between October 2018 and October 2023 in a single center were analyzed. Mortality data were acquired in cooperation with the National Statistic Office. We used a standard PRECISE-DAPT threshold ≥25. A Receiver Operating Characteristic (ROC) curve analysis was used to assess the predictive performance of the PRECISE-DAPT score for mortality with mean follow-up of 1.9 years. The area under the curve (AUC) was calculated for each group – myocardial infarction with ST-elevation (STEMI), myocardial infarction without ST-elevation (NSTEMI), and unstable angina pectoris (UAP) - to quantify discrimination ability, with higher values indicating better prediction. Results We included 3127 ACS patients hospitalized in a single centre. There were 35.3 % (n=1132) STEMI, 43.7% (n=1402) NSTEMI, 17.3% (n=554) UAP, and 3.8% (n= 123) classified as MINOCA. The mean age was 67.4 (SD 12.5), with 67.5% (n=2111) men. Previous myocardial infarction had 20% (n=622), stroke 9.7% (n=302), and heart failure 6.3% (n=197) of patients. At admission, 5.0% (n=160) of patients were in Killip class IV and 4.1% (n=130) in Killip class III. Mean ejection fraction was 47.5% (SD 11.7). PCI was performed in 78.7% (n=2460) and coronary artery bypass graft surgery (CABG) in 16.0% (n=499). The Precise DAPT score best predicts mortality in STEMI patients, AUC = 0.843 (95% confidence interval [CI] from 0.820 to 0.865), while its predictive ability is lower for NSTEMI 0.779 (95% CI from 0.756 to 0.801) and UAP 0.749 (95% CI from 0.708 to 0.787). A significant difference was observed between STEMI and the other groups, but not between UAP and NSTEMI. There was no difference in mortality prediction based on revascularization strategy: AUC =0.803 for PCI and 0.804 for CABG, respectively. ROC curves confirm that STEMI patients have the most distinct predictive difference (Figure 1). Conclusions The PRECISE-DAPT score may be used to assess mid-term all-cause mortality in acute coronary syndrome, with the best predictive ability for STEMI.ROC curves for ACS and mortality
No takes yet. Share an insight, caveat, or question.
Bauer et al. (2025) conducted an observational in acute coronary syndrome (n=3,127). PRECISE-DAPT score was evaluated on all-cause mortality (AUC 0.843, 95% CI 0.820-0.865). The PRECISE-DAPT score predicted mid-term all-cause mortality in acute coronary syndrome, with the highest predictive ability in STEMI patients (AUC 0.843; 95% CI 0.820-0.865).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: