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Curso de Atualização em Medicina Cardiovascular 2019
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Comparison of the PRECISE-DAPT and CRUSADE scores in ACS patients for the risk of major bleeding.
Session:
Posters 2 - Écran 1 - Doença Coronária
Speaker:
José P. Guimarães
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Posters
FP Number:
---
Authors:
José P. Guimarães; FM Gonçalves; S Borges; M Moz; J Trigo; PS Mateus; JI Moreira
Abstract
<p><strong>Background:</strong><br /> In Acute Coronary Syndrome (ACS) patients, major bleeding is a marker of worse short and long term prognosis and its risk should be assessed for therapeutic decisions. The PRECISE-DAPT score (PD) has been recently proposed as a bleeding risk score for decision–making in prolonged dual antiplatelet therapy and CRUSADE (CR) is an established score for the prediction of the in-hospital bleeding risk.</p> <p><strong>Objective:</strong><br /> Compare the predictive capacity of both scores in the risk of in-hospital and follow-up major bleeding in patients with ACS.</p> <p><strong>Methods:</strong><br /> Retrospective study of patients with ACS periodically included in our center registry between October/2012 and November/2017. The CR and PD scores were calculated for each patient. The ISTH definition for major bleeding was the primary endpoint for in hospital and at 1 year. Their predictive capacity was assessed by ROC curve analysis and net reclassification improvement.</p> <p><strong>Results:</strong><br /> We included 618 patients (67±13 years; 74% males; 44% STEMI patients). The average CR was 26.4±16.8 and the median PD was 17.9 (IQR: 9.7-28.7). The CR score classified 134 (21.7%) patients as high and very high risk (CR>40) and PD 213 (34.5%) as high risk (PD>25).</p> <p>During hospitalization 16 (2.6%) patients died and 30 (4.9%) had major bleeding. Both scores had a good predictive capability: CR AUC=0.82 (95%CI: 0.79-0.85) and PD AUC=0.80 (95%CI: 0.77-0.86) and there were no differences in reclassification analysis (p=.99).</p> <p>At 1 year, 32 (5.4%) patients died (3.4% from cardiovascular causes) and 30 (5.1%) had major bleeding. There were 2 intracranial bleedings. Major bleeding rate was increasingly higher in each category of the PD score (0%, 3.1%, 2.2%, 12.2%, p for trend <.001) and CR score (1.6%, 3.3%, 10.2%, 5.0%, 16.4% p for trend <.001).</p> <p>The PD and CR AUC were similar (PD: AUC= 0.79, 95%CI: 0.75-0.82 vs CR: AUC=0.76, 95%CI: 0.72-0.79; p=.27), however 25% of patients were appropriately reclassified with PD’s high risk category vs CR very high risk (NRI=0.25; p=.049). PD high risk category had 80% sensibility and 71% specificity for major bleeding at 1 year and CR very high risk category 33% sensibility and 90% specificity.</p> <p><strong>Conclusion:</strong><br /> The high incidence of major bleeding in the high risk groups should be regarded in the therapeutic strategy. The predictive power of both scores was similar for in-hospital bleeding, however, PRECISE-DAPT had a better performance in the follow-up by detecting a higher number of patients with major bleeding.</p>
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