Key result
The vast majority of elderly patients with STEMI have PRECISE-DAPT values above the recommended cut-off point for bleeding risk, suggesting different cut-offs may be needed.
Why the study?
Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in ACS, but no study had assessed its applicability in elderly patients.
Does the PRECISE-DAPT score accurately predict bleeding risk in elderly patients (≥75 years) with STEMI?
Cohort
Does the PRECISE-DAPT score accurately predict bleeding risk in elderly patients (≥75 years) with STEMI?
The standard PRECISE-DAPT cut-off of ≥25 is not discriminative for bleeding risk in elderly STEMI patients, suggesting age-specific cut-offs or quartiles are more appropriate.
Answers are grounded in this paper and cite their sources.
Challenges current PRECISE-DAPT thresholds in elderly STEMI; leaves open validation of age-specific cut-offs.
BACKGROUND: Elderly patients with acute coronary syndromes (ACS) are at higher risk both for ischemic and bleeding complications. Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting, but no study assessed its applicability in elderly patients. This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice. METHODS: The IFFANIAM registry included prospectively patients aged ≥ 75 years with ST segment elevation myocardial infarction (STEMI). Main outcome measured was the incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death). Bleeding risk was classified: (A) according to PRECISE-DAPT values above or not the recommended cut-off point (≥ 25); and (B) according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series (Q1: < 30; Q2: 30-35; Q3: 36-44; Q4: ≥ 45). CONCLUSIONS: The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk. Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.
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Guerrero et al. (2018) conducted a cohort in ST segment elevation myocardial infarction (STEMI). PRECISE-DAPT score was evaluated on incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death) (p== 0.038). The vast majority of elderly patients with STEMI have PRECISE-DAPT values above the recommended cut-off point for bleeding risk, suggesting different cut-offs may be needed.
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