Abstract
BackgroundMultiple 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.MethodsA 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.ResultsPost-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.ConclusionIn 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.Electronic supplementary materialThe online version of this article (10.1007/s12471-020-01486-y) contains supplementary material, which is available to authorized users.
Highlights
Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, represents the cornerstone of treatment for patients with acute coronary syndrome or after percutaneous coronary intervention (PCI) with drug-eluting stent implantation [1,2,3]
The baseline characteristics of the PRECISE-DAPT cohort were generally similar, the ReCre8 trial population had a lower incidence of prior bleeding (1.3% vs 1.9%)
Using PRECISEDAPT to stratify our trial population, less patients were categorised as low risk (65% vs 50%) or high risk (17% vs 24%) compared with the PRECISE-DAPT derivation cohort
Summary
Dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y12 inhibitor, represents the cornerstone of treatment for patients with acute coronary syndrome or after percutaneous coronary intervention (PCI) with drug-eluting stent implantation [1,2,3]. The risk scores of PRECISE-DAPT [6], PARIS [7] and CREDO-Kyoto [8] have been developed to assess the risks of both post-discharge ischaemic and bleeding events following PCI. We aimed to assess and to directly compare the predictive performance of currently used risk scores for post-discharge ischaemic or bleeding events in a contemporary all-comer population. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events. 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. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment
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