PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY

被引：50

作者：

Gragnano, Felice ^{[1
]}

Heg, Dik ^{[2
,3
]}

Franzone, Anna ^{[4
]}

McFadden, Eugene P. ^{[5
,6
]}

Leonardi, Sergio ^{[7
,8
]}

Piccolo, Raffaele ^{[4
]}

Vranckx, Pascal ^{[9
]}

Branca, Mattia ^{[2
,3
]}

Serruys, Patrick W. ^{[10
]}

Benit, Edouard ^{[11
]}

Liebetrau, Christoph ^{[12
,13
]}

Janssens, Luc ^{[14
]}

Ferrario, Maurizio ^{[7
,8
]}

Zurakowski, Aleksander ^{[15
]}

Diletti, Roberto ^{[16
]}

Dominici, Marcello ^{[17
]}

Huber, Kurt ^{[18
,19
]}

Slagboom, Ton ^{[20
]}

Buszman, Pawel ^{[15
,21
]}

Bolognese, Leonardo ^{[22
]}

Tumscitz, Carlo ^{[23
]}

Bryniarski, Krzysztof ^{[24
]}

Aminian, Adel ^{[25
]}

Vrolix, Mathias ^{[26
]}

Petrov, Ivo ^{[27
]}

Garg, Scot ^{[28
]}

Naber, Christoph ^{[29
]}

Prokopczuk, Janusz ^{[30
]}

Hamm, Christian ^{[12
,13
]}

Steg, Philippe Gabriel ^{[31
]}

Juni, Peter ^{[32
]}

Windecker, Stephan ^{[1
]}

Valgimigli, Marco ^{[33
]}

机构：

[1] Univ Bern, Dept Cardiol, Inselspital, Bern, Switzerland

[2] Univ Bern, Inst Social & Prevent Med, Bern, Switzerland

[3] Univ Bern, Clin Trials Unit, Bern, Switzerland

[4] Federico II Univ Naples, Dept Adv Biomed Sci, Naples, Italy

[5] Cardialysis Core Labs & Clin Trial Management, Rotterdam, Netherlands

[6] Cork Univ Hosp, Dept Cardiol, Cork, Ireland

[7] Univ Pavia, Dept Med Sci & Infect Dis, Pavia, Italy

[8] Fdn IRCCS Policlin San Matteo, Pavia, Italy

[9] Jessa Ziekenhuis, Dept Cardiol & Crit Care Med, Hartctr Hasselt, Hasselt, Belgium

[10] Imperial Coll London, Dept Cardiol, London, England

[11] Jessa Hosp, Dept Cardiol, Hasselt, Belgium

[12] Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany

[13] German Ctr Cardiovasc Res DZHK, Dept Cardiol, Partner Site RheinMain, Frankfurt, Germany

[14] Imelda Hosp, Dept Cardiol, Bonheiden, Belgium

[15] Amer Heart Poland, Dept Cardiol, Ctr Cardiovasc Res & Dev, Katowice, Poland

[16] Erasmus MC, Thoraxctr, Dept Cardiol, Rotterdam, Netherlands

[17] S Maria Univ Hosp, Dept Cardiol, Terni, Italy

[18] Wilhelminen Hosp, Med Dept 3, Cardiol, Vienna, Austria

[19] Sigmund Freud Univ, Dept Cardiol, Med Sch, Vienna, Austria

[20] OLVG Amsterdam, Dept Cardiol, Amsterdam, Netherlands

[21] Med Univ Silesia, Dept Epidemiol, Katowice, Poland

[22] Azienda Toscana Usl Sudest, Dept Cardiol, Arezzo, Italy

[23] St Anna Hosp, Dept Cardiol, Cardiol Unit, Ferrara, Italy

[24] Jagiellonian Univ Med Coll, John Paul II Hosp, Dept Cardiol, Krakow, Poland

[25] Ctr Hosp Univ Charleroi, Dept Cardiol, Charleroi, Belgium

[26] Ziekenhuis Oost Limburg, Dept Cardiol, Genk, Belgium

[27] Acibadem City Clin Cardiovasc Ctr, Dept Cardiol, Sofia, Bulgaria

[28] East Lancashire Hosp NHS Trust, Dept Cardiol, Blackburn, Lancs, England

[29] Klinikum Wilhelmshaven, Wilhelmshaven, Germany

[30] PAKS Kozle, Kedzierzyn Kozle, Poland

[31] Univ Paris Diderot, Hop Bichat, AP HP, Paris, France

[32] Univ Toronto, Appl Hlth Res Ctr, Dept Med, Li Ka Shing Knowledge Inst,St Michaels Hosp, Toronto, ON, Canada

[33] Cardioctr Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland

来源：

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY | 2022年 / 8卷 / 01期

关键词：

Dual antiplatelet therapy; Ticagrelor; Aspirin; Bleeding; Percutaneous coronary intervention; THERAPY; CLOPIDOGREL; VALIDATION; TICAGRELOR; DURATION; EVENTS;

D O I：

10.1093/ehjcvp/pvaa106

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims The five-item PRECISE-DAPT, integrating age, haemoglobin, white-blood-cell count, creatinine clearance, and prior bleeding, predicts bleeding risk in patients on dual antiplatelet therapy (DAPT) after stent implantation. We sought to assess whether the bleeding risk prediction offered by the PRECISE-DAPT remains valid among patients receiving ticagrelor monotherapy from 1 month onwards after coronary stenting instead of standard DAPT and having or not having centrally adjudicated bleeding endpoints. Methods and results The PRECISE-DAPT was calculated in 14 928 and 7134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict Bleeding Academic Research Consortium 3 or 5 bleeding was assessed and compared among patients on ticagrelor monotherapy (experimental strategy) or standard DAPT (reference strategy) from 1 month after drug-eluting stent implantation. Bleeding endpoints were investigatorreported or centrally adjudicated in GLOBAL LEADERS and GLASSY, respectively. At 2 years, the c-indexes for the score among patients treated with the experimental or reference strategy were 0.67 [95% confidence interval (CI): 0.63-0.71] vs. 0.63 (95% CI: 0.59-0.67) in GLOBAL LEADERS (P = 0.27), and 0.67 (95% CI: 0.61-0.73) vs. 0.66 (95% CI: 0.61-0.72) in GLASSY (P = 0.88). Decision curve analysis showed net benefit using the PRECISEDAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified four-item PRECISE-DAPT. Conclusion The PRECISE-DAPT offers a prediction model that proved similarly effective to predict clinically relevant bleeding among patients on ticagrelor monotherapy from 1 month after coronary stenting compared with standard DAPT and appears to be unaffected by the presence or absence of adjudicated bleeding endpoints.

引用

页码：28 / 38

页数：11

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