Key result
A high PRECISE-DAPT score was significantly associated with an increased 5-year risk of BARC 2, 3, or 5 bleeding compared to a low score (HR 1.721; 95% CI 1.180-2.511; P=0.005) in patients after PCI.
Why the study?
The long-term prognostic value of the guideline-recommended PRECISE-DAPT score in patients after PCI remained unclear.
Does the PRECISE-DAPT score predict 5-year bleeding and ischemic outcomes in patients undergoing PCI?
Cohort (n=10,109)
No
Does the PRECISE-DAPT score predict 5-year bleeding and ischemic outcomes in patients undergoing PCI?
Hazard Ratio: 1.721 (95% CI 1.18–2.511)
p-value: p=0.005
The PRECISE-DAPT score has statistically significant predictive value for 5-year bleeding events and moderate predictive value for all-cause death in Chinese patients post-PCI.
High PRECISE-DAPT scores flag elevated long-term mortality risk post-PCI; extends utility beyond short-term bleeding prediction in observational data.
AIMS: The PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent dual-antiplatelet therapy) score is recommended by guidelines for predicting out-of-hospital bleeding in patients after percutaneous coronary intervention (PCI). However, the long-term prognostic value of the PRECISE-DAPT score in patients after PCI remains unclear. METHODS AND RESULTS: We performed a prospective study of 10 724 patients who underwent PCI throughout 2013 in Fuwai Hospital. The bleeding endpoint was Bleeding Academic Research Consortium 2, 3, or 5 bleeding. The ischaemic endpoints were all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE). After a 5-year follow-up, 10 109 patients were finally analysed. A total of 415 (4.11%) patients experienced bleeding, 364 (3.60%) experienced all-cause death, and 2049 (20.27%) had MACCE. Using Cox regression, the risks of bleeding [hazard ratio (HR): 1.721, 95% confidence interval (CI): 1.180-2.511, P = 0.005], MACCE (HR: 1.607, 95% CI: 1.347-1.917, P < 0.001), and all-cause-death (HR: 3.902, 95% CI: 2.916-5.221, P < 0.001) in patients with a high score were significantly higher than those in patients with a low score. The PRECISE-DAPT score showed prognostic value for 5-year events of bleeding (C-statistic: 0.566, 95% CI: 0.537-0.594), MACCE (C-statistic: 0.540, 95% CI: 0.527-0.553), and all-cause death (C-statistic: 0.673, 95% CI: 0.644-0.702). CONCLUSION: After 5 years of follow-up, the PRECISE-DAPT score has a statistically significant predictive value for long-term bleeding events in the Chinese PCI population, and also some prognostic value for death and MACCE. ONE-SENTENCE SUMMARY: In this real-world, large-sample study, the PRECISE-DAPT (predicting bleeding complications in patients undergoing stent implantation and subsequent dual-antiplatelet therapy) score shows a statistically significant 5-year predictive value for bleeding in Chinese patients with percutaneous coronary intervention and dual-antiplatelet therapy. The study also shows that the PRECISE-DAPT score has moderate predictive value for all-cause death.
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Zhao et al. (2021) conducted a cohort in Percutaneous coronary intervention (PCI) (n=10,109). High PRECISE-DAPT score vs. Low PRECISE-DAPT score was evaluated on Bleeding Academic Research Consortium 2, 3, or 5 bleeding (HR 1.721, 95% CI 1.180-2.511, p=0.005). A high PRECISE-DAPT score was significantly associated with an increased 5-year risk of BARC 2, 3, or 5 bleeding compared to a low score (HR 1.721; 95% CI 1.180-2.511; P=0.005) in patients after PCI.
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