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Derivation and Validation of the PRECISE-HBR Score to Predict Bleeding After Percutaneous Coronary Intervention

医学 经皮冠状动脉介入治疗 传统PCI 队列 内科学 弗雷明翰风险评分 心肌梗塞 外科 疾病
作者
Felice Gragnano,David van Klaveren,Dik Heg,Lorenz Räber,Mitchell W. Krucoff,Sergio Raposeiras‐Roubín,Jurriën M. ten Berg,Sergio Leonardi,Takeshi Kimura,Noé Corpataux,Alessandro Spirito,James Hermiller,Emad Abu‐Assi,Dean R.P.P. Chan Pin Yin,Jaouad Azzahhafi,Claudio Montalto,M Galazzi,Sarah Bär,Raminta Kavaliauskaite,Fabrizio D’Ascenzo,Gaetano Maria De Ferrari,Hirotoshi Watanabe,Philippe Gabríel Steg,Deepak L. Bhatt,Paolo Calabrò,Roxana Mehran,Philip Urban,Stuart J. Pocock,Stephan Windecker,Marco Valgimigli
出处
期刊:Circulation [Ovid Technologies (Wolters Kluwer)]
被引量:1
标识
DOI:10.1161/circulationaha.124.072009
摘要

Background: Accurate bleeding risk stratification after percutaneous coronary intervention (PCI) is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of high bleeding risk patients. We derived and validated a novel bleeding risk score by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria. Methods: The derivation cohort comprised 29,188 patients undergoing PCI, of whom 1136 (3.9%) had a Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year, from four contemporary real-world registries and the XIENCE V USA trial. The PRECISE-DAPT score was refitted with a Fine-Gray model in the derivation cohort and extended with the ARC-HBR criteria. The primary outcome was BARC 3 or 5 bleeding within 1 year. Independent predictors of BARC 3 or 5 bleeding were selected at multivariable analysis (p<0.01). The discrimination of the score was internally assessed with apparent validation and cross-validation. The score was externally validated in 4578 patients from the MASTER DAPT trial and 5970 patients from the STOPDAPT-2 total cohort. Results: The PRECISE-HBR score (age, estimated glomerular filtration rate, hemoglobin, white-blood-cell count, previous bleeding, oral anticoagulation, and ARC-HBR criteria) showed an area under the curve (AUC) for 1-year BARC 3 or 5 bleeding of 0.73 (95% CI, 0.71–0.74) at apparent validation, 0.72 (95% CI, 0.70–0.73) at cross-validation, 0.74 (95% CI, 0.68–0.80) in the MASTER DAPT, and 0.73 (95% CI, 0.66–0.79) in the STOPDAPT-2, with superior discrimination than the PRECISE-DAPT (cross-validation: Δ AUC, 0.01; p=0.02; MASTER DAPT: Δ AUC, 0.05; p=0.004; STOPDAPT-2: Δ AUC, 0.02; p=0.20) and other risk scores. In the derivation cohort, a cut-off of 23 points identified 11,414 patients (39.1%) with a 1-year BARC 3 or 5 bleeding risk ≥4%. An alternative version of the score, including acute myocardial infarction on admission instead of white-blood-cell count, showed similar predictive ability. Conclusions: The PRECISE-HBR score is a contemporary, simple 7-item risk score to predict bleeding after PCI, offering a moderate improvement in discrimination over multiple existing scores. Further evaluation is required to assess its impact on clinical practice.

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