Key result
Paired ANZACS-QI risk scores accurately predict 1-year post-ACS ischaemic and bleeding events.
Why the study?
Recommended DAPT duration after ACS varies from 1 month to 1 year depending on ischaemic and bleeding risks, prompting the design of paired risk scores to inform this decision.
Do paired ischaemic and bleeding risk scores predict events from 28 days to 1 year post-ACS to guide DAPT duration?
Cohort (n=27,755)
Yes
Do paired ischaemic and bleeding risk scores predict events from 28 days to 1 year post-ACS to guide DAPT duration?
Paired ischaemic and bleeding risk scores developed from a national registry show moderate discrimination for predicting events 28 days to 1 year post-ACS, potentially aiding decisions on DAPT duration.
Answers are grounded in this paper and cite their sources.
May support paired post-ACS risk stratification; leaves open prospective validation for DAPT guidance.
OBJECTIVE: The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision. METHODS: New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score). FINDINGS: In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell's c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified. CONCLUSION: We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.
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Kerr et al. (2023) conducted a cohort in Acute coronary syndrome (n=27,755). Paired ANZACS-QI ischaemic and major bleeding risk prediction scores was evaluated on Ischaemic events (cardiovascular mortality or rehospitalisation for myocardial infarction or ischaemic stroke) and major bleeding events (bleeding mortality or rehospitalisation for bleeding) between 28 days and 1 year post-discharge (Harrell's c-statistic 0.75 (ischaemic) and 0.69 (bleeding), 95% CI 0.74-0.77). Paired ANZACS-QI risk scores predicted 28-day to 1-year post-ACS ischaemic (4.3%, c-statistic 0.75) and major bleeding events (2.0%, c-statistic 0.69) with good calibration.
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