Performance of PRECISE-DAPT and Age-Bleeding-Organ Dysfunction Score for Predicting Bleeding Complication During Dual Antiplatelet Therapy in Chinese Elderly Patients

Liang Dong; Cao Lu; Chen Wensen; Chen Fuzhong; Muhammad Khalid; Dong Xiaoyu; Li Guangjuan; Qian Yanxia; Zhang Yufeng; Liu Xinjian; Chen Leilei; Wang Junhong

doi:10.3389/fcvm.2022.910805

Performance of PRECISE-DAPT and Age-Bleeding-Organ Dysfunction Score for Predicting Bleeding Complication During Dual Antiplatelet Therapy in Chinese Elderly Patients

Front Cardiovasc Med. 2022 Jul 8:9:910805. doi: 10.3389/fcvm.2022.910805. eCollection 2022.

Authors

Liang Dong¹, Cao Lu¹, Chen Wensen², Chen Fuzhong¹, Muhammad Khalid¹, Dong Xiaoyu¹, Li Guangjuan³, Qian Yanxia¹, Zhang Yufeng³, Liu Xinjian¹, Chen Leilei¹, Wang Junhong^{1

3}

Affiliations

¹ Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
² Office of Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Department of Cardiology, Xinjiang Yili Friendship Hospital, Yili Kazak Autonomous Prefecture, Xinjiang, China.

Abstract

Background: Recently, the Age-Bleeding-Organ Dysfunction (ABO) algorithm was recommended by the Asian Pacific Society of Cardiology Consensus as a binary approach to evaluate bleeding risk. This analysis made comparison of the predictive performances between the PRECISE-DAPT and ABO bleeding score in identifying the risk of 12-months major bleeding in Chinese elderly patients over 65 years old patients who underwent percutaneous coronary intervention (PCI) during dual-antiplatelet therapy period.

Methods: A total of 2,037 elderly coronary artery disease (CAD) patients (≥65 years) receiving dual antiplatelet therapy (DAPT) after PCI were enrolled in the study. The predictive accuracy of the two bleeding risk scores (PRECISE-DAPT and ABO) was compared for identifying the risk of bleeding during the dual-antiplatelet therapy in patients who underwent PCI. Major clinically relevant bleeding events were defined according to the Bleeding Academic Research Consortium (BARC) criteria.

Results: The PRECISE-DAPT score in the no bleeding, BARC = 1 bleeding, BARC ≥ 2 bleeding patients was 23.55 ± 10.46, 23.23 ± 10.03, and 33.54 ± 14.33 (p < 0.001), respectively. Meanwhile, the ABO score in the three groups was 0.72 ± 0.80, 0.69 ± 0.81, and 1.49 ± 0.99 (p < 0.001), respectively. The C-statistic of the PRECISE-DAPT model for prediction of BARC ≥ 2 bleeding in overall patients was 0.717 (95% CI, 0.656-0.777) and 0.720 (95% CI, 0.656-0.784) in acute coronary syndrome (ACS) patients. Similar discriminatory capacity was demonstrated in the ABO risk score [overall, patients, AUC: 0.712 (95% CI, 0.650-0.774); ACS patients, AUC: 0.703 (95% CI, 0.634-0.772)]. No differences were observed when the ABO model was in comparison with the PRECISE-DAPT model, regardless in overall patients (z = -0.199, p = 0.842) or ACS patients (z = -0.605, p = 0.545). The calibration for BARC ≥ 2 bleeding of the PRECISE-DAPT and ABO score were acceptable, regardless in overall patients [goodness-of-fit (GOF) Chi-square = 0.432 and 0.001, respectively; p-value = 0.806 and 0.999, respectively] or ACS patients (GOF Chi-square = 0.008 and 0.580, respectively; p-value = 0.996 and 0.748, respectively).

Conclusion: No matter of clinical presentation in Asian 65-years older patients with DAPT, the PRECISE-DAPT, and ABO scores had the similar discriminative ability for 12-months BARC ≥ 2 bleeding. Considering the simplicity and reliability, the PRECISE-DAPT score might be more clinically applicable in the overall population and ACS patients in bleeding prediction.

Keywords: ABO score; PRECISE-DAPT; bleeding risk scores; dual-antiplatelet therapy; percutaneous coronary intervention.