R Rozemeijer1, W P van Bezouwen2, N D van Hemert2, J A Damen3, S Koudstaal2,4, M Stein2,5, G E Leenders2, L Timmers2,6, A O Kraaijeveld2, K Roes7, P Agostoni8, P A Doevendans2,9,10, P R Stella2, M Voskuil2. 1. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. r.rozemeijer@umcutrecht.nl. 2. Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 4. Farr Institute of Health Informatics, University College London, London, UK. 5. Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands. 6. St. Antonius Hospital, Nieuwegein, The Netherlands. 7. Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, The Netherlands. 8. Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium. 9. Netherlands Heart Institute, Utrecht, The Netherlands. 10. Central Military Hospital, Utrecht, The Netherlands.
Abstract
BACKGROUND: Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events. METHODS: A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell's c‑statistics net reclassification index and decision curve analyses. RESULTS: Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARIS ischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51-0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60-0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56-0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48-0.69) and PARIS (0.55, 95% CI 0.44-0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment. CONCLUSION: In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing.
BACKGROUND: Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events. METHODS: A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell's c‑statistics net reclassification index and decision curve analyses. RESULTS: Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARISischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51-0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60-0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56-0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48-0.69) and PARIS (0.55, 95% CI 0.44-0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment. CONCLUSION: In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing.
Authors: Ron Pisters; Deirdre A Lane; Robby Nieuwlaat; Cees B de Vos; Harry J G M Crijns; Gregory Y H Lip Journal: Chest Date: 2010-03-18 Impact factor: 9.410
Authors: Lars Wallentin; Richard C Becker; Andrzej Budaj; Christopher P Cannon; Håkan Emanuelsson; Claes Held; Jay Horrow; Steen Husted; Stefan James; Hugo Katus; Kenneth W Mahaffey; Benjamin M Scirica; Allan Skene; Philippe Gabriel Steg; Robert F Storey; Robert A Harrington; Anneli Freij; Mona Thorsén Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Usman Baber; Roxana Mehran; Gennaro Giustino; David J Cohen; Timothy D Henry; Samantha Sartori; Cono Ariti; Claire Litherland; George Dangas; C Michael Gibson; Mitchell W Krucoff; David J Moliterno; Ajay J Kirtane; Gregg W Stone; Antonio Colombo; Alaide Chieffo; Annapoorna S Kini; Bernhard Witzenbichler; Giora Weisz; Philippe Gabriel Steg; Stuart Pocock Journal: J Am Coll Cardiol Date: 2016-04-11 Impact factor: 24.094