Felice Gragnano, Dik Heg1, Anna Franzone2, Eugène P McFadden3, Sergio Leonardi4, Raffaele Piccolo2, Pascal Vranckx5, Mattia Branca1, Patrick W Serruys6, Edouard Benit7, Christoph Liebetrau8,9, Luc Janssens10, Maurizio Ferrario4, Aleksander Zurakowski11, Roberto Diletti12, Marcello Dominici13, Kurt Huber14,15, Ton Slagboom16, Paweł Buszman11,17, Leonardo Bolognese18, Carlo Tumscitz19, Krzysztof Bryniarski20, Adel Aminian21, Mathias Vrolix22, Ivo Petrov23, Scot Garg24, Christoph Naber25, Janusz Prokopczuk26, Christian Hamm8,9, Philippe Gabriel Steg27, Peter Jüni28, Stephan Windecker29, Marco Valgimigli30. 1. Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland. 2. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. 3. Cardialysis Core Laboratories and Clinical Trial Management, Rotterdam, the Netherlands and Department of Cardiology, Cork University Hospital, Cork, Ireland. 4. Department of Medical Sciences and Infective Disease, University of Pavia and Fondazione, IRCCS Policlinico San Matteo, Pavia, Italy. 5. Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Belgium. 6. Department of Cardiology, Imperial College of London, London, UK. 7. Department of Cardiology, Jessa Hospital, Hasselt, Belgium. 8. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 9. Department of Cardiology, German Center for Cardiovascular Research (DZHK), Partner Site RheinMain, Frankfurt am Main, Germany. 10. Department of Cardiology, Imelda Hospital, Bonheiden, Belgium. 11. Department of Cardiology, Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland. 12. Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands. 13. Department of Cardiology, S. Maria University-Hospital, Terni, Italy. 14. 3rd Medical Department, Cardiology, Wilhelminen Hospital, Vienna, Austria. 15. Department of Cardiology, Sigmund Freud University Medical School, Vienna, Austria. 16. Department of Cardiology, OLVG Amsterdam, Amsterdam, the Netherlands. 17. Department of Epidemiology, Medical University of Silesia, Katowice, Poland. 18. Department of Cardiology, Azienda Toscana Usl Sudest, Arezzo, Italy. 19. Department of Cardiology, Cardiology Unit Sant'Anna Hospital, Ferrara, Italy. 20. Department of Cardiology, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland. 21. Department of cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium. 22. Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium. 23. Department of Cardiology, Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria. 24. Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, UK. 25. Klinikum Wilhelmshaven, Wilhelmshaven, Germany. 26. PAKS Kozle, Poland. 27. Hôpital Bichat, AP-HP, Université Paris-Diderot, Paris, France. 28. Department of Medicine, Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, University of Toronto, Toronto, ON, Canada. 29. Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. 30. Cardiocentro Ticino, Via Tesserete 48 CH-6900 Lugano, Switzerland.
Abstract
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 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 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. Published on behalf of the European Society of Cardiology. All rights reserved.
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 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 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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Felice Gragnano; Marcel Zwahlen; Pascal Vranckx; Dik Heg; Kurt Schmidlin; Christian Hamm; Philippe Gabriel Steg; Giuseppe Gargiulo; Eugene P McFadden; Yoshinobu Onuma; Ply Chichareon; Edouard Benit; Helge Möllmann; Luc Janssens; Sergio Leonardi; Aleksander Zurakowski; Alessio Arrivi; Robert Jan Van Geuns; Kurt Huber; Ton Slagboom; Paolo Calabrò; Patrick W Serruys; Peter Jüni; Marco Valgimigli; Stephan Windecker Journal: J Am Heart Assoc Date: 2022-03-01 Impact factor: 6.106
Authors: Liang Dong; Cao Lu; Chen Wensen; Chen Fuzhong; Muhammad Khalid; Dong Xiaoyu; Li Guangjuan; Qian Yanxia; Zhang Yufeng; Liu Xinjian; Chen Leilei; Wang Junhong Journal: Front Cardiovasc Med Date: 2022-07-08