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PRECISE-DAPT score for bleeding prediction after acute coronary syndrome in patients treated with percutaneous coronary intervention for multivessel disease
Session:
Comunicações Orais (Sessão 2) - DAC e Cuidados Intensivos 1: Síndromes Coronárias Agudas
Speaker:
João Miguel Santos
Congress:
CPC 2022
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:
Comunicações Orais
FP Number:
---
Authors:
João Miguel Santos; Vanda Neto; Inês Pires; Joana Correia; Gonçalo Ferreira; Emanuel Correia
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">PRECISE-DAPT (PD) is a recently validated score for long-term bleeding prediction after percutaneous coronary intervention (PCI) with stenting in patients undergoing double antiplatelet therapy (DAPT). Our purpose was to evaluate if PD could predict bleeding events and mortality in patients hospitalized due to acute coronary syndrome (ACS) undergoing PCI for multivessel disease at index hospitalization.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods </strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective analysis of 804 patients admitted to a Cardiology ward due to ACS, planned to undergo PCI and treated with DAPT (aspirin + P2Y12 inhibitor) for a minimum of 12 months. Bleeding event was defined as any Thrombolysis in Myocardial Infarction criteria (TIMI) minor or major bleeding. Kaplan-Meier survival plots were used to evaluate the predictive power of PD score on 12-month bleeding events (12MB) and 12-month mortality (12MM). Cox-regression analysis was used to evaluate the independent prognostic value of the PD score on the mentioned outcomes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">191 patients were excluded either due to DAPT<12 months, left main disease or Heart Team decision for conservative management/bypass graft surgery. Mean patient age was 65 (±13); 75.8% were men. 38% had ST-elevation myocardial infarction. 78% were treated with potent P2Y12 inhibitors. 77%, 18.8% and 4.2% of patients, respectively, were submitted to PCI of 1, 2 and 3 or more vessels. 12MB event rate was 4.7%. 12MM was 8.2%. Kaplan-Meier analysis stratified by high <em>vs</em> non-high bleeding risk using PD score (PD < or ≥25) revealed significantly</span><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black"> lower median time to </span></span></span><span style="font-family:Calibri,sans-serif"> 12MB in high-risk subgroup (349.8±2.8 vs 362.2±2.8 days, bleeding rate: 8.2% <em>vs</em> 1.6%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>: 24.606, <em>p</em><0.01). High-risk PD score predicted 12MB events in patients treated with PCI, irrespective of the number of vessels treated (bleeding events 8.1% <em>vs</em> 1.4%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>:12.688, <em>p</em><0.01 for 1 vessel PCI; 13.3% <em>vs</em> 2.8%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>:4.106, <em>p</em>=0.04 for 2 vessel PCI; 0% <em>vs</em> 33.3%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>: 4.530, <em>p</em>=0.03 for ≥3 vessels PCI). 12MM analysis revealed that high bleeding risk patients had significantly lower median time to death (305±5.7 vs 353±2.6 days, mortality rate: 19.9% <em>vs</em> 4.4%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>: 63.35, p<0.01). Only high-risk patients submitted to 1 vessel-PCI, however, had significantly lower median time to death (314±10.1 vs 361±1.9, mortality rate: 17.6% <em>vs</em> 2.0%, <span style="background-color:white"><span style="color:black">χ</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup>: 37.111, <em>p</em><0.01) after stratified analysis. Cox regression analysis revealed that PD score was an independent predictor of 12MB (HR: 1.183, <em>p</em><0.01), even when accounting for other bleeding risk factors, such as platelet count, alcoholism, hypertension and type of arterial access used for PCI.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients treated with PCI after ACS with a high bleeding risk, as assessed by PD score, have significantly higher risk of 12MB events, irrespective of the number of vessels treated at the index event. PD might be a useful tool for long-term bleeding prediction, and may support the decision of DAPT duration after ACS in multivessel disease.</span></span></p>
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