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PRECISE-DAPT score for long-term bleeding prediction after acute coronary syndrome
Session:
Painel 7 -Doença Coronária 5
Speaker:
João Miguel Santos
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
João Miguel Santos; Inês Pires; Luísa Gonçalves; Joana Laranjeira Correia; Hugo Da Silva Antunes; Inês Almeida; Emanuel Correia; José Costa Cabral
Abstract
<p><strong>Introduction</strong></p> <p>PRECISE-DAPT (PD) is a recently validated score for long-term bleeding prediction after coronary stenting in patients undergoing double antiplatelet therapy (DAPT). We aimed to evaluate its predictive power on long-term bleeding events and mortality compared to other bleeding risk scores, namely CRUSADE, ACTION and a score validated by Mehran et al obtained from analysis of the ACUITY/HORIZONS AMI 3 trials, in patients hospitalized for acute coronary syndrome (ACS).</p> <p> </p> <p><strong>Methods </strong></p> <p>Retrospective analysis of 993 patients admitted for ACS, planned to undergo DAPT with aspirin and a P2Y12 inhibitor for a minimum of 12 months, regardless of revascularization strategy. Bleeding event was defined as Thrombolysis in Myocardial Infarction minor or major bleeding. Mentioned scores were calculated for each patient. ROC curves were used to ascertain score predictive capacity for 12-month bleeding events (12MB) and 12-month mortality (12MM). Kaplan-Meier and Cox-regression analysis of 12MB and 12MM was performed. </p> <p> </p> <p><strong>Results</strong></p> <p>Mean age was 69±13y; 69.2% were men. 42% had ST-elevation myocardial infarction. 75% of patients were treated with coronary stenting (PCI), 4.4% with coronary artery bypass graft surgery and 20.6% underwent conservative management.</p> <p>Mean of scores were: CRUSADE 35±15, Mehran 18±8, ACTION 29±8, PD 24±13.</p> <p>12MB was 4.5%. 12MM was 11.7%.</p> <p>ROC curve analysis for 12MB revealed that PD score had the highest discriminative power (AUC:0.813, p<0.001), with lower values for other scores. ROC curve analysis for 12MM mortality revealed that ACTION score had the highest discriminative power (AUC:0.797, p<0.001), closely followed by PD score (AUC: 0.749, p<0.001).</p> <p>Kaplan-Meier analysis stratified by high <em>vs</em> non-high bleeding risk (PD< or ≥25) using PD revealed significantly increased 12MB in high-risk group (8.0% <em>vs</em> 1.6%, χ<sup>2</sup>: 23.43, p<0.001).</p> <p>When stratified by type of treatment – PCI or no PCI – PD score was a predictor of 12MB regardless of treatment modality (10.3% <em>vs</em> 1.6%, χ<sup>2</sup>: 21.965, p<0.001 for PCI group; 8.6% <em>vs</em> 1.0%, χ<sup>2</sup>: 5.676, p=0.017 for non-PCI).</p> <p>12MM analysis by Kaplan-Meier revealed that high-risk patients by PD had higher mortality, in comparison with non-high-risk patients (19.9% <em>vs</em> 4.4%, χ<sup>2</sup>: 63.35, p<0.001).</p> <p>Cox-regression analysis of PD revealed that it was an independent predictor for 12MB (HR: 1.143, p<0.001) and 12MM (HR:1.14, p<0.028), even after adjustment for other risk factors, such as diabetes, platelet count, alcoholism, ejection fraction, number of diseased coronary vessels and max troponin level at index event.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>In comparison with other bleeding-risk scores, PD was the best predictor of 12MB events in a population with recent ACS on DAPT. Patients with a high bleeding risk as assessed by PD score have significantly higher 12MB and 12MM, independently from other bleeding-risk factors. PD is a useful tool and may aid in the decision of DAPT duration after ACS.</p>
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