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Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI
BACKGROUND: Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. METHODS: We investigated PD Score in 994 patients after percutaneous coronary int...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973296/ https://www.ncbi.nlm.nih.gov/pubmed/33763519 http://dx.doi.org/10.1016/j.ijcha.2021.100750 |
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author | Dannenberg, Lisa Afzal, Shazia Czychy, Natalia M'Pembele, René Zako, Saif Helten, Carolin Mourikis, Philipp Zikeli, Dorothee Ahlbrecht, Samantha Trojovsky, Kajetan Benkhoff, Marcel Barcik, Maike Wolff, Georg Zeus, Tobias Kelm, Malte Polzin, Amin |
author_facet | Dannenberg, Lisa Afzal, Shazia Czychy, Natalia M'Pembele, René Zako, Saif Helten, Carolin Mourikis, Philipp Zikeli, Dorothee Ahlbrecht, Samantha Trojovsky, Kajetan Benkhoff, Marcel Barcik, Maike Wolff, Georg Zeus, Tobias Kelm, Malte Polzin, Amin |
author_sort | Dannenberg, Lisa |
collection | PubMed |
description | BACKGROUND: Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. METHODS: We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. RESULTS: 524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01–8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36–9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52–2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12–5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26–3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden’s index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24). CONCLUSION: In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events. |
format | Online Article Text |
id | pubmed-7973296 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-79732962021-03-23 Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI Dannenberg, Lisa Afzal, Shazia Czychy, Natalia M'Pembele, René Zako, Saif Helten, Carolin Mourikis, Philipp Zikeli, Dorothee Ahlbrecht, Samantha Trojovsky, Kajetan Benkhoff, Marcel Barcik, Maike Wolff, Georg Zeus, Tobias Kelm, Malte Polzin, Amin Int J Cardiol Heart Vasc Original Paper BACKGROUND: Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. METHODS: We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. RESULTS: 524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01–8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36–9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52–2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12–5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26–3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden’s index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24). CONCLUSION: In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events. Elsevier 2021-03-13 /pmc/articles/PMC7973296/ /pubmed/33763519 http://dx.doi.org/10.1016/j.ijcha.2021.100750 Text en © 2021 Published by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Paper Dannenberg, Lisa Afzal, Shazia Czychy, Natalia M'Pembele, René Zako, Saif Helten, Carolin Mourikis, Philipp Zikeli, Dorothee Ahlbrecht, Samantha Trojovsky, Kajetan Benkhoff, Marcel Barcik, Maike Wolff, Georg Zeus, Tobias Kelm, Malte Polzin, Amin Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title | Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title_full | Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title_fullStr | Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title_full_unstemmed | Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title_short | Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI |
title_sort | risk prediction of bleeding and macce by precise-dapt score post-pci |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973296/ https://www.ncbi.nlm.nih.gov/pubmed/33763519 http://dx.doi.org/10.1016/j.ijcha.2021.100750 |
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