Accuracy in precise DAPT score compared with CRUSADE score in Thai population

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Rajavithi hospital Introduction Myocardial infarction is one of the most common cardiovascular disease in the world including Thai population. The current treatment strategy is percutaneous coronary intervention (PCI) with drug eluting stent (DES) which need to receive aspirin and P2Y12 inhibitor called Dual antiplatelets (DAPT) The previous studies showed unwanted bleeding in patients who received DAPT. Many scores are developed and valid to use as indicator of bleeding risk. However, the study of accuracy, performance and validity of Precise DAPT and CRUSADE score in Thailand are still limited. Method and Materials This is retrospective study of Thai patients aged 20 – 85 years old diagnose with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) who underwent PCI with DES and took DAPT for 6 months in CCS and 1 year in ACS at Rajavithi hospital from 2017 to 2019. Exclusion criteria are patients who take anticoagulant, previous major bleeding, currently received DAPT. We calculated the Precise DAPT score and CRUSADE score of the enrolled patients and follow up the bleeding events for 1 year. Objectives The primary outcome is the accuracy of the Precise DAPT score and the secondary outcome is to compare the performance of the Precise DAPT and Crusade score. Results Total of 90 patients were enrolled in this study with mean age of 63 ± 11.8 years old. Mainly are males (73.3%). The diagnosis of patients with STEMI 31.1%, NSTEMI/UA 38.8% and CCS 30.0%. The bleeding events defined by TIMI major and minor bleeding were 6 patients comprised of 1 TIMI major and 5 TIMI minor events. The bleeding events in Precise DAPT score < 25 were 3 of 47 patients (6.4%) compared with Precise DAPT score ³25 were 3 of 43 patients (7.0%) The events of bleeding in CRUSADE score <31 were 2 of 39 patients (5.1%), CRUSADE score 31-40 were 2 of the 17 patients (11.8%) and CRUSADE score > 40 were 2 of 34 patients (5.9%). The accuracy of Precise DAPT and CRUSADE score to predict TIMI major bleeding by ROC curve were excellence with AUC of Precise DAPT score = 0.955 (95%CI 0.912-0.998) and AUC of CRUSADE score =0.966 (95%CI 0.927-1.000). However, the Accuracy of Precise DAPT score and CRUSADE score to predict TIMI major and minor bleeding by ROC curve were poor with AUC = 0.529 (95%CI 0.250-0.799) and AUC = 0.531 (95%CI 0.254-0.807) respectively. The sensitivity and specificity of the cut-off ³ 25 point in Precise DAPT is 50.0 % and 57.1%%, respectively. While the sensitivity and specificity of the cut-off > 40 in CRUSADE score is 33.0% and 63.1% respectively. Conclusions This study showed that Precise DAPT score with cut-off ³ 25 and CRUSADE score with cut-off >40 have excellent accuracy to predict TIMI major bleeding but poor accuracy on TIMI minor bleeding in patients who take DAPT after PCI with DES.