Claudio Montalto1, Gabriele Crimi2, Nuccia Morici3, Luigi Piatti4, Daniele Grosseto5, Paolo Sganzerla6, Giovanni Tortorella7, Roberta De Rosa8, Leonardo De Luca9, Giuseppe De Luca10, Tullio Palmerini11, Marco Valgimigli12, Stefano Savonitto4, Stefano De Servi13. 1. Division of Cardiology, Fondazione IRCCS Policinico San Matteo, Pavia, Italy. 2. Division of Cardiology, Fondazione IRCCS Policinico San Matteo, Pavia, Italy; Interventional Cardiology Unit, Cardio-Thoraco-Vascular Department, Ospedale Policlinico San Martino IRCCS, Genova, Italy. Electronic address: gabriele.crimi@hsanmartino.it. 3. First Division of Cardiology, Niguarda Ca'Grande Hospital, Milano, Italy. 4. Division of Cardiology, Ospedale Manzoni, Lecco, Italy. 5. Division of Cardiology, Ospedale Infermi, Rimini, Italy. 6. Division of Cardiology, Ospedale Treviglio-Caravaggio, Treviglio, Italy. 7. Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 8. Department of Cardiology, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno, Italy; Department of Cardiology, Goethe University Hospital, Frankfurt am Main, Germany. 9. Division of Cardiology, Department of Cardiosciences, Roma, Italy. 10. Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Novara, Italy. 11. Cardiovascular Department, Policlinico S. Orsola, Bologna, Italy. 12. Cardiocentro Ticino, Lugano, University of Bern, Inselspital, Bern, Switzerland. 13. University of Pavia, Pavia, Italy.
Abstract
BACKGROUND: We sought to assess and compare the prediction power of the PRECISE-DAPT and PARIS risk scores with regards to bleeding events in elderly patients suffering from acute coronary syndromes (ACS) and undergoing invasive management. METHODS: Our external validation cohort included 1883 patients older >74 years admitted for ACS and treated with PCI from 3 prospective, multicenter trials. RESULTS: After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3-5 bleedings (p = 0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (p = 0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2 > 0.05), but PARIS risk score was associated to a greater overestimation of the risk (p = 0.02). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. CONCLUSIONS: In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance.
BACKGROUND: We sought to assess and compare the prediction power of the PRECISE-DAPT and PARIS risk scores with regards to bleeding events in elderly patients suffering from acute coronary syndromes (ACS) and undergoing invasive management. METHODS: Our external validation cohort included 1883 patients older >74 years admitted for ACS and treated with PCI from 3 prospective, multicenter trials. RESULTS: After a median follow-up of 365 days, patients in the high-risk categories according to the PRECISE-DAPT score experienced a higher rate of BARC 3-5 bleedings (p = 0.002) while this was not observed for those in the high-risk category according to the PARIS risk score (p = 0.3). Both scores had a moderate discriminative power (c-statistics 0.70 and 0.64, respectively) and calibration was accurate for both risk scores (all χ2 > 0.05), but PARIS risk score was associated to a greater overestimation of the risk (p = 0.02). Decision curve analysis was in favor of the PRECISE-DAPT score up to a risk threshold of 2%. CONCLUSIONS: In the setting of older adults managed invasively for ACS both the PARIS and the PRECISE-DAPT scores were moderately accurate in predicting bleeding risk. However, the use of the PRECISE-DAPT is associated with better performance.