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PRECISE-DAPT score for long-term bleeding prediction after acute coronary syndrome in patients managed without percutaneous coronary intervention
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
João Miguel Santos
Congress:
CPC 2021
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; Vanda Neto; Joana Correia; Luísa Gonçalves; Inês Almeida; 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 can also predict long-term bleeding and mortality in patients hospitalized due to acute coronary syndrome (ACS) and managed with conservative therapy (CT) or surgical myocardial revascularization (CABG).</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">We conducted a retrospective analysis of 993 patients admitted to a Cardiology ward due to 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 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 impact of PD score on these 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">Mean patient age was 69 (±13) years; 69.2% were men. 42% had ST-elevation myocardial infarction. 74% of patients were treated with stent implantation (PCI), 12.3% with CABG and 13.7% underwent CT. 81% of patients maintained DAPT for at least 12 months of follow-up. 12MB event rate was 4.5%. 12MM was 11.7%. Kaplan-Meier analysis stratified by low <em>vs</em> high bleeding risk (PD < or ≥25, respectively), according to PD score, revealed significantly increased 12MB risk in the high-risk group (1.6% <em>vs </em>8.2%, <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>: 23.41, p<0.001). When stratified by type of treatment – PCI, CABG or CT – PD score was a significant predictor of 12MB in patients treated with PCI or CT, but not in patients treated with CABG (10.5% <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>: 21.844, p<0.001 for PCI group; 9.5% <em>vs</em> 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>: 4.918, p=0.027 for CT; 8.6% <em>vs</em> 2%, <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>: 2.370, p=0.124 for CABG). 12MM analysis revealed that high bleeding risk patients, as defined by PD, had significantly higher mortality, in comparison with lower-risk patients (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<0.001). When stratified by treatment, however, despite the fact that patients with high-risk PD score had numerically worse survival in all 3 subgroups, the results were statistically significant for PCI subgroup only (16% <em>vs</em> 2.9%, <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>: 32.551, p<0.001). Cox regression analysis revealed that PD score is an independent predictor of 12MB (HR: 1.096, p<0.001) and 12MM (HR:1.076, p<0.001), regardeless of therapeutic managment</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">, even when accounting for other risk factors such as diabetes, platelet count, alcoholism and hypertension.</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 or CT after ACS, with a high bleeding risk as assessed by PD score, have significantly higher risk of 12MB and 12MM. PD score might be a useful tool for long-term bleeding prediction and may aid in the decision of DAPT duration after ACS, even in patients who are not suitable for coronary revascularization.</span></span></p>
Slides
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