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The association of PRECISE-DAPT score with ischemic outcomes in patients taking dual antiplatelet therapy following percutaneous coronary intervention: a meta analysis


Eur Heart J Cardiovasc Pharmacother. 2021 Nov 24:pvab080. doi: 10.1093/ehjcvp/pvab080. Online ahead of print.

ABSTRACT

AIMS: The PRECISE-DAPT score identifies patients at high risk of bleeding complications following percutaneous coronary intervention (PCI). International guidelines recommend the PRECISE-DAPT to identify patients at high risk for bleeding, who may benefit from shortened dual antiplatelet therapy (DAPT). The association of the PRECISE-DAPT score to ischemic outcomes remains unclear. We performed a meta-analysis investigating the association between a high PRECISE-DAPT score and ischemic outcomes.

METHODS AND RESULTS: A comprehensive literature search was conducted on articles published between March 11, 2017 and June 5, 2021. Two reviewers independently screened articles for inclusion using pre-defined criteria. Outcome measures extracted included: composite ischemic events, major bleeding events and all-cause mortality. A random effects model was applied to obtain combined risk estimates for outcomes. From 12 included studies, there were 39459 patients with PRECISE-DAPT <25 and 14761 patients with PRECISE-DAPT ≥ 25. PRECISE-DAPT score ≥ 25 was associated with increased risk of composite ischemic events [OR 2.16; 95% CI 1.77-2.65], myocardial infarction [OR 2.06; 95% CI 1.38-3.08] and ischemic stroke [OR 2.90; 95% CI 1.76-4.78]. Patients with a PRECISE-DAPT score ≥ 25 had increased risk of major bleeding [OR 3.62; 95% CI 2.62-4.99]. Patients with a PRECISE-DAPT score ≥ 25 had higher risk of all-cause mortality [OR 5.83; 95% CI 5.37-6.33].

CONCLUSION: Patients with a PRECISE-DAPT score ≥ 25 are at increased risk for ischemic events, bleeding, and all-cause mortality. Prospective evaluation of a PRECISE-DAPT guided antiplatelet therapy approach is required to demonstrate benefit in this high-risk population.

PMID:34849686 | DOI:10.1093/ehjcvp/pvab080

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