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CC BY-NC-ND 4.0 · Thromb Haemost 2020; 120(07): 1087-1095
DOI: 10.1055/s-0040-1712449
Cellular Haemostasis and Platelets

Comparative Assessment of Predictive Performance of PRECISE-DAPT, CRUSADE, and ACUITY Scores in Risk Stratifying 30-Day Bleeding Events

Hideyuki Kawashima
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
,
Chao Gao
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
3   Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
,
Kuniaki Takahashi
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
,
Mariusz Tomaniak
4   First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
,
Masafumi Ono
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
,
Hironori Hara
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
,
Rutao Wang
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
3   Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
,
Ply Chichareon
5   Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Harry Suryapranata
3   Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
,
Simon Walsh
6   Department of Cardiology, Belfast Health and Social Care Trust, Belfast, United Kingdom
,
James Cotton
7   Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
,
Rene Koning
8   Clinique Saint-Hilaire, Rouen, France
,
Benno Rensing
9   Sint-Antonius Ziekenhuis, Nieuwegein, The Netherlands
,
Joanna Wykrzykowska
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
,
Robbert J. de Winter
1   Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
,
Scot Garg
10   East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
,
Richard Anderson
11   Cardiff and Vale University Health Board, Wales, United Kingdom
,
Christian Hamm
12   Kerckhoff Heart Center, Campus University of Giessen, Bad Nauheim, Germany
,
Philippe Gabriel Steg
13   Assistance Publique–Hôpitaux de Paris, INSERM U-1148, FACT (French Alliance for Cardiovascular Trials), Hôpital Bichat, Université de Paris, Paris, France
14   Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, United Kingdom
,
Yoshinobu Onuma
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
,
Patrick W. Serruys
2   Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
15   NHLI, Imperial College London, London, United Kingdom
› Author Affiliations Funding The GLOBAL LEADERS study was sponsored by the European Clinical Research Institute, which received funding from AstraZeneca, Biosensors International, and the Medicines Company. The study funders had no role in trial design, data collection, analysis, interpretation of the data, preparation, approval, or making decision to submit the manuscript or publication.
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Abstract

Background The utility of the PRECISE-DAPT score in predicting short-term major bleeding, either alone, or in comparison with the CRUSADE and ACUITY scores, has not been investigated. This analysis compared the predictive performances of the three bleeding scores in stratifying the risk of 30-day major bleeding postpercutaneous coronary intervention in patients with dual-antiplatelet therapy.

Methods In this post hoc subanalysis of the GLOBAL LEADERS trial, the primary safety objective (bleeding according to the Bleeding Academic Research Consortium [BARC] criteria [type 3 or 5]) was assessed at 30 days according to the three scores in the overall population, and in patients with acute (ACS) and chronic coronary syndrome (CCS).

Results In a total of 15,968 patients, we calculated all three scores in 14,709 (92.1%). Irrespective of clinical presentation, the PRECISE-DAPT (c-statistics: 0.648, 0.653, and 0.641, respectively), CRUSADE (c-statistics: 0.641, 0.639, and 0.644, respectively), and ACUITY (c-statistics: 0.633, 0.638, and 0.623, respectively) scores were no significant between-score differences in discriminatory performance for BARC 3 or 5 bleeding up to 30 days, and similarly the PRECISE-DAPT score had a comparable discriminative capacity according to the integrated discrimination improvement when compared with the other scores. In ACS, the CRUSADE score had a poor calibration ability (Hosmer–Lemeshow goodness-of-fit [GOF] chi-square = 15.561, p = 0.049), whereas in CCS, the PRECISE-DAPT score had poor calibration (GOF chi-square = 15.758, p = 0.046).

Conclusion The PRECISE-DAPT score might be clinically useful in the overall population and ACS patients for the prediction of short-term major bleeding considering its discriminative and calibration abilities.

Keywords

bleeding scores - major bleeding - percutaneous coronary intervention - dual-antiplatelet therapy - discrimination - calibration


Publication History

Received: 22 February 2020

Accepted: 19 April 2020

Article published online:
22 June 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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