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Precise DAPT score for prediction of outcomes in patients treated with percutaneous coronary intervention for proximal left anterior descending artery.
Session:
Sessão de Posters 36 - Antiagregação plaquetar
Speaker:
Oliver Correia Kungel
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Oliver Correia Kungel; Vanda Devesa Neto; António Costa; Inês Pires; Joana Correia; Gonçalo Ferreira; João Gouveia Fiuza; Mariana Duarte Almeida; Francisco Rodrigues Dos Santos
Abstract
<p style="text-align:justify"><strong><em>Introduction: </em></strong>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 12 months-mortality in patients hospitalized due to acute coronary syndrome (ACS) undergoing PCI proximal left anterior descending artery (pLAD) and compared to other validated bleeding score (CRUSADE score). </p> <p style="text-align:justify"><br /> <em><strong>Methods:</strong></em> 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). Receiver Operating Characteristic (ROC) curve analysis was conducted to compare the performance of both the PD score and the CRUSADE score in predicting outcomes.</p> <p style="text-align:justify"><br /> <em><strong>Results: </strong></em> 233 patients were included; mean patient age was 68 (±13); 75% were men. 53.4% had ST-elevation myocardial infarction. 78%, 16% and 6% of patients, respectively, were submitted to PCI of 1, 2 and 3 or more vessels. 12MB event rate was 5.9%. 12MM was 14.8%. Kaplan-Meier analysis stratified by high vs non-high bleeding risk using PD score (PD < or ≥25) revealed significantly lower median time to 12MB in high-risk subgroup (362.2±2.8 vs 352.2±6.4 days, bleeding rate: 8.1% vs 1.1%, χ2: 4.702, p=0.03). 12MM analysis revealed that high bleeding risk patients had significantly lower median time to death (days to event 353.4±6.6 vs 292.2±16.1; mortality rate: 23.9% vs 3.2%, χ2: 16.09, p<0.01). ROC curve analysis demonstrated that PD score had better predictive analysis to 12MM (AUC PD 0.804 vs AUC CRUSADE 0.689) and 12MB (AUC PD 0.883 vs AUC CRUSADE 0.552) when compared with CRUSADE score. </p> <p style="text-align:justify"><br /> <em><strong>Conclusion:</strong></em> Patients treated with PCI to pLAD disease after ACS with a high bleeding risk, as assessed by PD score, have significantly higher risk of 12MB and 12MM events. PD might be a useful tool for long-term bleeding prediction and may support the decision of DAPT duration after ACS in these patients. </p>
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