Key result
High PRECISE-HBR score is linked to ~2.9-fold higher post-PCI bleeding risk with cangrelor.
Why the study?
Cangrelor is recommended to prevent periprocedural thrombotic events in P2Y12 inhibitor-naive patients undergoing PCI, but bleeding risk scores have not been definitely validated in cangrelor-treated patients.
Does the PRECISE-HBR score predict early BARC type 2-5 bleeding and net adverse clinical events within 48 hours in patients undergoing PCI treated with cangrelor?
Observational (n=1,067)
Does the PRECISE-HBR score predict early BARC type 2-5 bleeding and net adverse clinical events within 48 hours in patients undergoing PCI treated with cangrelor?
In PCI patients treated with cangrelor, the PRECISE-HBR score identified 41.4% of patients as high bleeding risk and demonstrated modest discrimination for predicting 48-hour BARC 2-5 bleeding and NACE, supporting its utility for early risk stratification.
Modest discrimination of PRECISE-HBR warrants caution for 48-hour bleeding prediction in cangrelor-treated PCI; leaves open its role in early risk stratification.
Background Cangrelor is recommended for the prevention of periprocedural thrombotic events in P2Y12 inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI). Bleeding risk scores have not been definitely validated in cangrelor-treated patients. Aim We assessed the performance of the PRECISE-HBR score in PCI patients receiving cangrelor. Methods Consecutive patients undergoing PCI with cangrelor enrolled in the ICARUS registry were analyzed to assess the ability of the PRECISE-HBR score in predicting Bleeding Academic Research Consortium (BARC) type 2-5 bleeding within 48 hours. The associations between the PRECISE-HBR score and 48-hour BARC 2-5 bleeding and net adverse clinical events (NACE) were also assessed. Results Among 1,067 patients undergoing PCI with cangrelor, the PRECISE-HBR score demonstrated modest discrimination (c-statistic 0.66, 95% CI 0.58-0.73) in predicting BARC 2-5 bleeding at 48 hours. The score classified 442 patients (41.4%) at high bleeding risk (HBR) (score ≥23). At 48 hours, BARC 2-5 bleeding (7.9% vs. 2.9%; odds ratio [OR] 2.91, 95% CI 1.63-5.21, p<0.001) and NACE (9.8% vs. 3.8%; OR 2.71, 95% CI 1.62-4.53, p<0.001) were more frequent in HBR than in non-HBR patients. Natural spline analyses showed a consistent, graded association between the PRECISE-HBR score and the risk of BARC 2-5 bleeding and NACE at 48 hours. Conclusions Among patients undergoing PCI treated with cangrelor, the PRECISE-HBR score identified 41% of patients at HBR and showed modest ability in predicting early bleeding. The PRECISE-HBR score was associated with BARC 2-5 bleeding and NACE at 48 hours, which supports its role for early risk stratification in this setting.
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Sio et al. (2026) conducted an observational in Patients undergoing percutaneous coronary intervention (PCI) treated with cangrelor (n=1,067). PRECISE-HBR score ≥23 (High Bleeding Risk) vs. PRECISE-HBR score <23 (non-High Bleeding Risk) was evaluated on Bleeding Academic Research Consortium (BARC) type 2-5 bleeding within 48 hours (OR 2.91, 95% CI 1.63-5.21, p=<0.001). The PRECISE-HBR score (≥23) predicted higher 48-hour BARC 2-5 bleeding in cangrelor-treated PCI patients (7.9% vs 2.9%; OR 2.91, 95% CI 1.63-5.21) with modest discrimination (c-statistic 0.66).
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