Key result
The PRECISE-DAPT score demonstrated comparable discriminative capacity to the CRUSADE and ACUITY scores for predicting 30-day major bleeding post-PCI, with a c-statistic of 0.648 versus 0.641 and 0.633, respectively.
Why the study?
The utility of the PRECISE-DAPT score in predicting short-term major bleeding, alone or compared with CRUSADE and ACUITY scores, had not been investigated.
Does the PRECISE-DAPT score accurately predict 30-day major bleeding in post-PCI patients on DAPT compared to the CRUSADE and ACUITY scores?
Cohort (n=14,709)
Open-label
Yes
Does the PRECISE-DAPT score accurately predict 30-day major bleeding in post-PCI patients on DAPT compared to the CRUSADE and ACUITY scores?
Absolute Event Rate: 0.648% vs 0.641%
p-value: p=0.531
The PRECISE-DAPT score performs similarly to the CRUSADE and ACUITY scores for predicting 30-day major bleeding post-PCI, but may be more clinically useful due to its simpler calculation and better calibration in ACS patients.
Modest bleeding score performance warrants caution in early post-PCI decisions; leaves open need for refined tools in prospective validation.
Background The utility of the PRECISE-DAPT score in predicting short-term major bleeding, either alone, or in comparison with the CRUSADE and ACUITY scores, has not been investigated. This analysis compared the predictive performances of the three bleeding scores in stratifying the risk of 30-day major bleeding postpercutaneous coronary intervention in patients with dual-antiplatelet therapy. Methods In this post hoc subanalysis of the GLOBAL LEADERS trial, the primary safety objective (bleeding according to the Bleeding Academic Research Consortium [BARC] criteria [type 3 or 5]) was assessed at 30 days according to the three scores in the overall population, and in patients with acute (ACS) and chronic coronary syndrome (CCS). Results In a total of 15,968 patients, we calculated all three scores in 14,709 (92.1%). Irrespective of clinical presentation, the PRECISE-DAPT (c-statistics: 0.648, 0.653, and 0.641, respectively), CRUSADE (c-statistics: 0.641, 0.639, and 0.644, respectively), and ACUITY (c-statistics: 0.633, 0.638, and 0.623, respectively) scores were no significant between-score differences in discriminatory performance for BARC 3 or 5 bleeding up to 30 days, and similarly the PRECISE-DAPT score had a comparable discriminative capacity according to the integrated discrimination improvement when compared with the other scores. In ACS, the CRUSADE score had a poor calibration ability (Hosmer–Lemeshow goodness-of-fit [GOF] chi-square = 15.561, p = 0.049), whereas in CCS, the PRECISE-DAPT score had poor calibration (GOF chi-square = 15.758, p = 0.046). Conclusion The PRECISE-DAPT score might be clinically useful in the overall population and ACS patients for the prediction of short-term major bleeding considering its discriminative and calibration abilities.
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Kawashima et al. (2020) conducted a cohort in Percutaneous coronary intervention with dual-antiplatelet therapy (n=14,709). PRECISE-DAPT score vs. CRUSADE and ACUITY scores was evaluated on Predictive performance (c-statistic) for BARC 3 or 5 bleeding at 30 days (95% CI 0.617-0.679, p=0.531). The PRECISE-DAPT score demonstrated comparable discriminative capacity to the CRUSADE and ACUITY scores for predicting 30-day major bleeding post-PCI, with a c-statistic of 0.648 versus 0.641 and 0.633, respectively.
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