Key result
PRECISE-DAPT cancer score links to ~2.6-fold higher bleeding risk in high-risk patients.
Why the study?
The PRECISE-DAPT cancer score previously demonstrated better accuracy than the original PRECISE-DAPT score in predicting bleeding events in patients with cancer, warranting external validation.
Does the PRECISE-DAPT cancer score improve the prediction of 1-year bleeding events compared to the original PRECISE-DAPT score in patients presenting with acute myocardial infarction and cancer?
Cohort (n=13,932)
Yes
Does the PRECISE-DAPT cancer score improve the prediction of 1-year bleeding events compared to the original PRECISE-DAPT score in patients presenting with acute myocardial infarction and cancer?
External validation demonstrates that the PRECISE-DAPT cancer score improves 1-year bleeding risk discrimination and reclassification over the original PRECISE-DAPT score in acute myocardial infarction patients with cancer.
Answers are grounded in this paper and cite their sources.
May support cancer-modified PRECISE-DAPT for bleeding stratification in AMI; extends validation but leaves open prospective confirmation before practice change.
AIMS: We aimed to externally validate the PRECISE-DAPT cancer score which showed better accuracy in predicting bleeding events in patients with cancer than the original PRECISE-DAPT score. METHODS: We used data from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) project. We compared the performance and clinical usefulness of the original score and the cancer score by calculating the C-statistic, the net reclassification index (NRI), and decision curve analysis. RESULTS: A total of 13,932 patients were included, of which 864 patients had a diagnosis of cancer at the time of presentation with an AMI. According to the original PRECISE DAPT score, 63.3% of patients with cancer were classified as HBR, whereas 94.9% of patients with cancer were classified as HBR according to the cancer score. Cox-regression models showed that patients classified as HBR by the updated cancer score have higher odds of bleeding (HR 2.6, 95% CI 2.1-3.1) events than patients classified as HBR by the original score (HR 2.2, 95% CI 1.8-2.7). The cancer score showed higher discrimination ability (C-statistic 0.66) than the original score (C-statistic 0.64). The overall NRI of the cancer score was 2.7%. The decision curves analysis showed that the cancer score use is roughly identical to the original score in patients without cancer but superior to the original score in patients with cancer. CONCLUSION: The PRECISE-DAPT cancer score is a valid and useful tool for the prediction of bleeding risk in patients with cancer and presenting with AMI.
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Dafaalla et al. (2025) conducted a cohort in Acute myocardial infarction with or without concomitant cancer (n=13,932). PRECISE-DAPT cancer score (5-item bleeding risk score adding cancer as a binary variable to age, prior hemorrhage, creatinine clearance, and hemoglobin) vs. Original simplified 4-item PRECISE-DAPT score was evaluated on Any bleeding event requiring hospitalization and/or red cell transfusion concentrates within 1 year post-discharge (HR 2.6, 95% CI 2.1-3.1). The PRECISE-DAPT cancer score showed higher 1-year bleeding discrimination (C-statistic 0.66 vs 0.64) and risk prediction for HBR patients (HR 2.6, 95% CI 2.1-3.1) than the original score.
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