Prognostic Role of the PRECISE-DAPT Score in Acute Coronary Syndrome and Different Antithrombotic Treatment Strategies

INTRODUCTION: The PRECISE-DAPT score is a useful tool for predicting the risk of bleeding after percutaneous coronary intervention (PCI) requiring dual antiplatelet therapy. We aimed to validate the PRECISE-DAPT score as a mid-term mortality predictor in acute coronary syndrome (ACS). METHODS: All patients with ACS hospitalized between October 2018 and October 2023 were analyzed. Mortality data were acquired in cooperation with the Institute of Health Information and Statistics of the Czech Republic. 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 a mean follow-up of 1.9 years. Area under the curve (AUC) was calculated for each ACS subtype and different antithrombotic strategy regimes at discharge to quantify discrimination ability, with higher values indicating better prediction. RESULTS: We included 2953 patients with ACS. There were mostly men (69.1%, n = 2040), 37.1% ST-elevation myocardial infarction (STEMI, n = 1095), 45.2% non-ST-elevation myocardial infarction (NSTEMI, n = 1336) and 17.7% unstable angina pectoris (UAP, n = 522) patients. The mean age was 67.4 (SD 12.5) years. There were 78.4% patients treated by PCI (n = 2314). The PRECISE-DAPT score best predicts mortality in STEMI, AUC = 0.84 (95% confidence interval [CI] from 0.82 to 0.87), while its predictive ability is lower for NSTEMI, 0.78 (95% CI from 0.76 to 0.80) and UAP 0.75 (95% CI from 0.71 to 0.79). Antithrombotic treatment strategy at discharge does not influence the predictive ability of the PRECISE-DAPT score (AUC = 0.78, 071 and 0.72 for dual antiplatelet therapy, dual antithrombotic therapy, and triple therapy, respectively), p = 0.61. CONCLUSIONS: The PRECISE-DAPT score may be used for predicting mid-term all-cause mortality in acute coronary syndrome, with the best predictive ability in STEMI. The standard threshold ≥ 25 maintain acceptable prognostic performance regardless of antithrombotic treatment strategy at discharge.