PRECISE-DAPT, ARC-HBR, or Simplified Clinical Evaluation for the Prediction of Major Bleeding After Percutaneous Coronary Intervention in older Patients

Abstract

Elderly patients have been remarkably under-represented in bleeding risk cohorts. Thus, the PRECISE-DAPT and ARC-HBR scores are not validated in older adults. Therefore, we sought to evaluate the PRECISE-DAPT and ARC-HBR scores in an exclusively elderly population and furthermore assess the prognostic value of a truly simplified clinical evaluation (SCE), consisting of only 3 binary clinical variables (hemoglobin <11g/dL, prior bleeding and anticipated use of anticoagulants). This is a retrospective analysis of the prospective single-center Elderly-HCD registry. Consecutive patients of ≥75 years of age that underwent percutaneous coronary intervention in the period of 2012-2019 were included. The primary endpoint was post discharge bleeding (PDB) at 12 months follow-up, defined according to the BARC 3/5 criteria. A total of 693 patients with a mean age of 81 (± 4.4) years were included in the study and 60 (6.8%) patients met the primary endpoint. The PRECISE-DAPT and ARC-HBR scores did not significantly predict PDB in Cox-regression models (HR: 1.65 (0.78-3.42) and 1.46 (0.72-4.24), respectively), whereas the SCE outperformed both scores (HR: 2.47 (1.34-4.49)). All 3 scores exhibited a moderate discriminatory potential as determined by ROC-curve analysis (AUCs 0.601, 0.621 and 0.616, respectively) with no significant differences when comparing either of them. The SCE showed an IDI of 0.25, p=0.02 (SCE vs ARC-HBR) and 0.24, p=0.01 (SCE vs PRECISE-DAPT); with NRI of 6.54%, p=0.37 and 7.12%, p=0.43, respectively. In conclusion, both the PRECISE-DAPT score and ARC-HBR criteria showed insufficient predictive value in older adults. A truly SCE, consisting of 3 easily accessible variables, not only provides equal discriminatory potential but also demonstrates superior predictive value as determined by cox-regression models. This makes it a highly appealing tool for risk stratification, pending its evaluation in larger prospective studies.