A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making - 06/05/20

Doi : 10.1016/j.ahj.2020.01.014

Francesco Costa, MD ^a, David van Klaveren, PhD ^b, Antonio Colombo, MD ^c, Fausto Feres, MD ^d, Lorenz Räber, MD ^e, Thomas Pilgrim, MD ^e, Myeong-Ki Hong, MD ^f,^g, Hyo-Soo Kim, MD ^h, Stephan Windecker, MD ^e, Ewout W. Steyerberg, PhD ^b, Marco Valgimigli, MD ^e,^{^⁎}
, for the
PRECISE-DAPT Study Investigators
^a Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Italy
^b Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, The Netherlands
^c Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
^d Istituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
^e Swiss Cardiovascular Center Bern, Bern University Hospital
^f Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
^g Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
^h Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea

^⁎Reprint requests: Marco Valgimigli MD PhD FESC, Swiss Cardiovascular Center Bern, University of Bern, CH-3010, Bern, Switzerland.Swiss Cardiovascular Center BernUniversity of BernBernCH-3010Switzerland

Abstract

The originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy¹ duration after PCI. It is unknown if a simplified version of the score based on 4 factors (age, hemoglobin, creatinine clearance, prior bleeding), and lacking white-blood cell count, retains potential to guide DAPT duration. The 4-item PRECISE-DAPT was used to categorize 10,081 patients who were randomized to short (3-6 months) or long (12-24 months) DAPT regimen according to high (HBR defined by PRECISE-DAPT ≥25 points) or non-high bleeding risk (PRECISE-DAPT<25) status. Long treatment duration was associated with higher bleeding rates in HBR (ARD +2.22% [95% CI +0.53 to +3.90]) but not in non-HBR patients (ARD +0.25% [−0.14 to +0.64]; p_int = 0.026), and associated with lower ischemic risks in non-HBR (ARD −1.44% [95% CI −2.56 to −0.31]), but not in HBR patients (ARD +1.16% [−1.91 to +4.22]; p_int = 0.11). Only non-HBR patients experienced lower net clinical adverse events (NACE) with longer DAPT (p_int = 0.043). A 4-item simplified version of the PRECISE-DAPT score retains the potential to categorize patients who benefit from prolonged DAPT without concomitant bleeding liability from those who do not.

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☆	Funding: No additional external funding was used Disclosures: The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.

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Vol 223

P. 44-47 - mai 2020 Retour au numéro

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A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making - 06/05/20

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