Key result
PRECISE-DAPT score ≥33 linked to ~277% greater BARC ≥2 bleeding risk in elderly patients on DAPT.
Why the study?
To determine the incidence and risk factors of bleeding events and assess the performance of the PRECISE-DAPT score in elderly patients aged 75 years or older undergoing PCI and 1-year DAPT.
Observational (n=940)
Yes
Effect estimate: OR 3.772 (95% CI 1.229, 11.578)
Absolute Event Rate: 8.25% vs 1.46%
p-value: p=0.02
In elderly patients (≥75 years) receiving DAPT after PCI, a PRECISE-DAPT score cutoff of 33 is more accurate than the standard guideline-recommended cutoff of 25 for predicting BARC ≥2 bleeding events.
Supports higher PRECISE-DAPT cutoff for bleeding risk in elderly post-PCI patients; hypothesis-generating and requires prospective validation before practice change.
Purpose: To determine the incidence and risk factors of bleeding events as well as assess the performance of the PRECISE-DAPT score in elderly patients (≥75 years) who underwent percutaneous coronary intervention (PCI) and one-year dual antiplatelet therapy (DAPT). Methods: A total of 940 patients (≥75 years) who received PCI and one-year DAPT were retrospectively enrolled into the study. The multivariable logistic regression analysis was conducted to identify risk factors of antiplatelet-related bleeding complications. The receiver operating characteristic (ROC) curve analysis and the Delong test were performed to obtain the optimized PRECISE-DAPT score. Results: It was observed that 89 (9.47%) patients suffered bleeding complications, while 37 (3.94%) of them had the Bleeding Academic Research Consortium (BARC, type ≥2) bleeding events. We stratified the PRECISE-DAPT score in tertiles (T1: ≤23; T2:24 to 32; T3: ≥33) and found that BARC ≥ 2 type bleeding occurred more frequently in T3 than in T1 and T2 (8.25 vs. 1.46% vs. 2.40%, p <0.05). The ROC curve analysis revealed that the PRECISE-DAPT score cutoff for BARC ≥2 type bleeding prediction was 33. In comparison with the current recommended cutoff score of 25 (AUC: 0.608, based on ROC analysis), the Delong test indicated significantly improved ability for predicting BARC ≥ 2 type bleeding events using the proposed cutoff value of 33, AUC of 0.676 ( p = 0.03), and Brier Score of 0.04. The multivariable logistic regression analysis demonstrated that the PRECISE-DAPT score ≥ 33 [OR: 3.772; 95% CI (1.229, 11.578); p = 0.02] was associated with BARC ≥ 2 type bleeding event, along with a history of hemorrhagic stroke [OR: 6.806; 95% CI (1.465, 31.613); p = 0.014], peptic ulcer [OR: 3.871; 95% CI (1.378, 10.871); p = 0.01], and/or myocardial infarction [MI, OR: 3.081; 95% CI (1.140, 8.326); p = 0.027]. Conclusion: A higher PRECISE-DAPT score of 33 might be a more reasonable cutoff value for predicting BARC ≥2 type bleeding risk in CAD patients (≥75 years). In addition, the history of hemorrhagic stroke, peptic ulcer, and myocardial infarction were identified as the risk factors of BARC ≥2 type bleeding events.
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Qian et al. (2021) conducted an observational in Coronary artery disease requiring percutaneous coronary intervention and dual antiplatelet therapy (n=940). PRECISE-DAPT score ≥33 vs. PRECISE-DAPT score ≤23 was evaluated on BARC ≥2 type bleeding events (OR 3.772, 95% CI 1.229, 11.578, p=0.02). A PRECISE-DAPT score ≥33 was significantly associated with an increased risk of BARC ≥2 type bleeding events (OR 3.772) in elderly patients receiving one-year DAPT after coronary stenting.
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