Bleeding risk prediction in elderly patients managed invasively for acute coronary syndromes: External validation of the PRECISE-DAPT and PARIS scores. (1st April 2021)

• Record Type: Journal Article
• Authors: Montalto, Claudio; Crimi, Gabriele; Morici, Nuccia; Piatti, Luigi; Grosseto, Daniele; Sganzerla, Paolo; Tortorella, Giovanni; De Rosa, Roberta; De Luca, Leonardo; De Luca, Giuseppe; Palmerini, Tullio; Valgimigli, Marco; Savonitto, Stefano; De Servi, Stefano
• Is Part Of: International journal of cardiology. Volume 328(2021)
• Page Start: 22
• Page End: 28
• Publication Date: 2021-04-01
• Subjects: Acute coronary syndromes -- ACS -- Elderlies -- Dual antiplatelet therapy -- DAPT -- Risk scores -- Bleeding -- PRECISE-DAPT -- PARIS; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2020.11.065
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: We sought to assess and compare the prediction power of the PRECISE-DAPT and PARIS risk scores with regards to bleeding events in elderly patients suffering from acute coronary syndromes (ACS) and undergoing invasive management. Methods: Our external validation cohort included 1883 patients older >74 years admitted for ACS and treated with PCI from 3 prospective, multicenter trials. Results: After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3–5 bleedings ( p = 0.002) while this was not observed for those in the high-risk category according to the PARIS risk score ( p = 0.3). Both scores had a moderate discriminative power ( c -statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ 2 > 0.05), but PARIS risk score was associated to a greater overestimation of the risk ( p = 0.02). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. Conclusions: In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance. Highlights: In a validation cohort of 1883 subjects older ≥75 y, the PRECISE-DAPT and PARIS risk scores had similar, moderate performance in terms of calibration and discrimination. The PRECISE-DAPT risk score had a better performance in stratifying patients into bleeding risk categories with a significant increase in terms of major bleeding in the high-risk category. An overestimation bias is present for both risk scores, but this appears significantly higher in the PARIS risk score.