Background: The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicians at individ- ualizing the optimal dual antiplatelet therapy duration (DAPT) after percutaneous coronary intervention (PCI). Nevertheless, external validation of these RSs it has not yet been performed in ACS (acute coronary syndrome) patients treated with prasugrel or ticagrelor in a real- world scenario. Methods: 4424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to Decem- ber 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-statis- tic = 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.

Comparative external validation of the PRECISE-DAPT and PARIS risk scores in 4424 acute coronary syndrome patients treated with prasugrel or ticagrelor

D'ascenzo F.;Peyracchia M.;GRAVINESE, CAROL;Rinaldi M.;Montabone A.;Rossini R.;Autelli M.;Giustetto C.;Quadri G.;Pozzi R.;
2020

Abstract

Background: The PRECISE-DAPT and PARIS risk scores (RSs) were recently developed to help clinicians at individ- ualizing the optimal dual antiplatelet therapy duration (DAPT) after percutaneous coronary intervention (PCI). Nevertheless, external validation of these RSs it has not yet been performed in ACS (acute coronary syndrome) patients treated with prasugrel or ticagrelor in a real- world scenario. Methods: 4424 ACS patients who underwent PCI and survived to hospital discharge, from January 2012 to Decem- ber 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-statis- tic = 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.
301
-
200
206
www.elsevier.com/locate/ijcard
Bleeding; DAPT; PARIS risk score; Prasugrel; PRECISE DAPT; Ticagrelor
Bianco M.; D'ascenzo F.; Raposeiras Roubin S.; Kinnaird T.; Peyracchia M.; Ariza-Sole A.; Cerrato E.; Manzano-Fernandez S.; Gravinese C.; Templin C.; Destefanis P.; Velicki L.; Luciano A.; Xanthopoulou I.; Rinaldi M.; Rognoni A.; Varbella F.; Boccuzzi G.; Omede P.; Montabone A.; Bernardi A.; Taha S.; Rossini R.; Durante A.; Gili S.; Magnani G.; Autelli M.; Grosso A.; Blanco P.F.; Giustetto C.; Garay A.; Quadri G.; Queija B.C.; Srdanovic I.; Paz R.C.; Fernandez M.C.; Pousa I.M.; Gallo D.; Morbiducci U.; Dominguez-Rodriguez A.; Lopez-Cuenca A.; Cequier A.; Alexopoulos D.; Iniguez-Romo A.; Pozzi R.; Assi E.A.; Valgimigli M.
File in questo prodotto:
File Dimensione Formato  
Bianco et al- post-print.pdf

Accesso aperto con embargo fino al 22/11/2020

Descrizione: Articolo completo
Tipo di file: POSTPRINT (VERSIONE FINALE DELL’AUTORE)
Dimensione 1.52 MB
Formato Adobe PDF
1.52 MB Adobe PDF Visualizza/Apri
Comparative external validation.pdf

Accesso riservato

Tipo di file: PDF EDITORIALE
Dimensione 510.5 kB
Formato Adobe PDF
510.5 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2318/1721549
Citazioni
  • ???jsp.display-item.citation.pmc??? 6
  • Scopus 20
  • ???jsp.display-item.citation.isi??? 19
social impact