Journal article
PRECISE-DAPT score for bleeding risk prediction in patients on dual or single antiplatelet regimens: insights from the GLOBAL LEADERS and GLASSY.
- Gragnano F Department of Cardiology, Inselspital, University of Bern.
- Heg D Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
- Franzone A Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
- McFadden EP Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands and Department of Cardiology, Cork University Hospital, Cork, Ireland.
- Leonardi S University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy.
- Piccolo R Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy.
- Vranckx P Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium.
- Branca M Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland.
- Serruys PW Department of Cardiology, Imperial College of London, London, United Kingdom.
- Benit E Jessa Hospital, Department of Cardiology, Hasselt, Belgium.
- Liebetrau C Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK), partner site RheinMain, Frankfurt am Main, Germany.
- Janssens L Imelda Hospital, Bonheiden, Belgium.
- Ferrario M University of Pavia and Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy.
- Zurakowski A Center of Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.
- Diletti R Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
- Dominici M S. Maria University-Hospital, Terni, Italy.
- Huber K 3rd Medical Department, Cardiology, Wilhelminenhospital, and Sigmund Freud University Medical School, Vienna, Austria.
- Slagboom T OLVG Amsterdam, Amsterdam, the Netherlands.
- Buszman P Center for Cardiovascular Research and Development American Heart of Poland, and Department of Epidemiology, Medical University of Silesia, Katowice, Poland.
- Bolognese L Azienda Toscana Usl Sudest, Arezzo, Italy.
- Tumscitz C Cardiology Unit Sant'Anna Hospital, Ferrara, Italy.
- Bryniarski K Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland.
- Aminian A Department of cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium.
- Vrolix M Ziekenhuis Oost Limburg, Genk, Belgium.
- Petrov I Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria.
- Garg S East Lancashire Hospitals NHS Trust, Blackburn, UK.
- Naber C Klinikum Wilhelmshaven, Wilhelmshaven, Germany.
- Prokopczuk J PAKS Kozle, Poland.
- Hamm C Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany and German Center for Cardiovascular Research (DZHK); Partner site RheinMain, Frankfurt am Main, Germany.
- Steg PG Hôpital Bichat, AP-HP, Université Paris-Diderot, Paris, France.
- Jüni P Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine, University of Toronto, Ontario, Canada.
- Windecker S Department of Cardiology, Inselspital, University of Bern.
- Valgimigli M Cardiocentro Ticino, Lugano, Switzerland.
- 2020-09-17
Published in:
- European heart journal. Cardiovascular pharmacotherapy. - 2020
English
AIMS
The 5-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 7,134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict BARC 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 investigator-reported 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 PRECISE-DAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified 4-item PRECISE-DAPT.
CONCLUSIONS
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.
The 5-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 7,134 patients from GLOBAL LEADERS and GLASSY trials, respectively. The ability of the score to predict BARC 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 investigator-reported 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 PRECISE-DAPT to guide bleeding risk assessment under both treatment strategies. Results were consistent between investigator-reported and adjudicated endpoints and using the simplified 4-item PRECISE-DAPT.
CONCLUSIONS
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.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/ehjcvp/pvaa106
- PMID 32941620
- Persistent URL
- https://folia.unifr.ch/global/documents/285442
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