Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor.
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Bianco Matteo, D'ascenzo Fabrizio, Raposeiras Roubin Sergio, Kinnaird Tim, Peyracchia Mattia, Ariza-Solé Albert, Cerrato Enrico, Manzano-Fernández Sergio, Gravinese Carol, Templin Christian, Destefanis Paola, Velicki Lazar, Luciano Alessia, Xanthopoulou Ioanna, Rinaldi Mauro, Rognoni Andrea, Varbella Ferdinando, Boccuzzi Giacomo, Omedè Pierluigi, Montabone Andrea, Bernardi Alessandro, Taha Salma, Rossini Roberta, Durante Alessandro, Gili Sebastiano, Magnani Giulia, Autelli Michele, Grosso Alberto, Blanco Pedro Flores, Giustetto Carla, Garay Alberto, Quadri Giorgio, Queija Berenice Caneiro, Srdanovic Ilija, Paz Rafael Cobas, Fernández María Cespón, Pousa Isabel Muñoz, Gallo Diego, Morbiducci Umberto, Dominguez-Rodriguez Alberto, Lopez-Cuenca Ángel, Cequier Angel, Alexopoulos Dimitrios, Iñiguez-Romo Andres, Pozzi Roberto, Assi Emad Abu, Valgimigli Marco
Аннотация
METHODS: 4424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to December 2016 at 12 European centers, were included. PRECISE-DAPT and PARIS bleeding RS, as well as PARIS ischemic RS, were computed, and their performance at predicting major bleeding (MB; BARC type 3 or 5) and ischemic events (MI and stent thrombosis) during follow up was compared.
RESULTS: After a median follow-up of 14 (interquartile range 12-20.9) months, 83 (1.88%) patients developed MB and 133 (3.0%) suffered an ischemic episode. PRECISE-DAPT performed better than PARIS bleeding RS (c-statistic = 0.653 vs. 0.593; p = .01 for comparison) in predicting MB. The RSs performance for MB prediction remained consistent in STEMI patients (c-statistic = 0.632 vs 0.575) or in those treated with prasugrel (c-statistic = 0.623 vs 0.586). PARIS ischemic RS exhibited superior discrimination in predicting ischemic complications compared to PRECISE-DAPT (c-statistic = 0.604 vs 0.568 p = .05 for comparison).
CONCLUSION: Our data provide support to the use of PRECISE-DAPT in MB risk stratification for patients receiving DAPT in form of aspirin and prasugrel or ticagrelor whereas the PARIS ischemic RS has potential to complement the risk prediction with respect to ischemic events.