Iranian Heart Journal

Iranian Heart Journal

The Predictive Value of the PRECISE-DAPT Score in Patients With ST-Segment-Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

Document Type : Original Article

Authors
Aly Mohamed Tohamy
madonna atef waheeb
Hatem Abdel Rahman Helmi
Cardiology Department, Faculty of Medicine, Assiut University, Egypt.
Abstract
Background: Recent guidelines recommend the use of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score for bleeding risk stratification and determining the appropriate duration of DAPT following primary percutaneous coronary intervention (PPCI). Our study aimed to assess the predictive value of the PRECISE-DAPT score for not only bleeding complications but also in-hospital and short-term complications, including major adverse cardiovascular events (MACEs) and no-reflow.
 
Methods: The study included 241 patients diagnosed with STEMI and eligible for PPCI. The patients were divided into 3 groups according to their PRECISE-DAPT score value: low (<17), intermediate (17–24), and high (≥25) score groups. Finally, in-hospital and short-term (180 d) follow-ups for MACEs, no-reflow, and bleeding complications were done.
 
Results: In-hospital and short-term complications were higher among the high-score group than in the other groups (P<0.001). The high-score group had lower thrombosis in myocardial infarction (TIMI flow<III) than the other groups, which was statistically significant (P= 0.001). The PRECISE-DAPT score had good predictive power for in-hospital complications (AUC=0.64) and short-term follow-up MACEs (AUC=0.80; P=0.004 and P<0.001, respectively), demonstrating good sensitivity and specificity of the PRECISE-DAPT score for the prediction of in-hospital complications, no-reflow, bleeding complications, and follow-up MACEs.
 
Conclusions: The PRECISE-DAPT score had a strong and independent predictive value for in-hospital, short-term MACEs, no-reflow, and bleeding complications among STEMI patients treated with PPCI. (Iranian Heart Journal 2024; 25(2): 35-46)
Keywords
ST-elevation myocardial infarction
PRECISE-DAPT score
MACEs
No-reflow
  1. Buccheri S., Capranzano P., Condorelli A., Scalia M., Tamburino C., Capodanno D. Risk stratification after ST-segment elevation myocardial infarction. Expert Review of Cardiovascular Therapy. 2016; 14(12):1349–1360. doi: 10.1080/14779072.2017.1256201
  2. Costa, D. van Klaveren, S. James, D. Heg, L. Raber, F. Feres, et al., Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials, Lancet. 389 (2017) 1025–1034.
  3. Fourth Universal Definition of Myocardial Infarction (2018). J Am CollCardiol 2018;Aug 25.
  4. Williams B, Mancia G, Spiering W, AgabitiRosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur heart J. 2018 Sep 1;39(33):3021-104
  5. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.Nephron.1976; 16:31–41.
  6. 2018 ESC/EACTS Guidelines on myocardial revascularization
  7. Sarkar A, Grigg WS, Lee JJ. TIMI grade flow.StatPearls [Internet]. 2020 Aug 16.
  8. Gibson CM, Cannon CP, Daley WL, Dodge JT, Jr., Alexander B, Jr., Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93(5):879-88. doi: 10.11
  9. Vranckx P, White HD, Huang Z, Mahaffey KW, Armstrong PW, Van de Werf F, Moliterno DJ, Wallentin L, Held C, Aylward PE, Cornel JH. Validation of BARC bleeding criteria in patients with acute coronary syndromes: the TRACER trial. Journal of the American College of Cardiology. 2016 May 10;67(18):2135-44.
  10. Mrdovic I, Savic L, Krljanac G, Asanin M, Perunicic J, Lasica R, Marinkovic J, Kocev N, Vasiljevic Z, Ostojic M. Predicting 30-day major adverse cardiovascular events after primary percutaneous coronary intervention. The RISK-PCI score. International journal of cardiology. 2013 Jan 20;162(3):220-7
  11. Vranckx P, White HD, Huang Z, Mahaffey KW, Armstrong PW, Van de Werf F, Moliterno DJ, Wallentin L, Held C, Aylward PE, Cornel JH. Validation of BARC bleeding criteria in patients with acute coronary syndromes: the TRACER trial. Journal of the American College of Cardiology. 2016 May 10;67(18):2135-44.
  12. Dannenberg L, Afzal S, Czychy N, M'Pembele R, Zako S, Helten C, Mourikis P, Zikeli D, Ahlbrecht S, Trojovsky K, Benkhoff M. Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI. IJC Heart & Vasculature. 2021 Apr 1;33:100750.
  13. Tanik VO, Cinar T, Arugaslan E, Karabag Y, Hayiroglu MI, Cagdas M, Rencuzogullari I, Uluganyan M. The predictive value of PRECISE-DAPT score for in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Angiology. 2019 May;70(5):440-7.
  14. Ando T, Nakazato K, Kimishima Y, Kiko T, Shimizu T, Misaka T, Yamada S, Kaneshiro T, Yoshihisa A, Yamaki T, Kunii H. The clinical value of the PRECISE-DAPT score in predicting long-term prognosis in patients with acute myocardial infarction. IJC Heart & Vasculature. 2020 Aug 1;29:100552.
  15. Yildirim E, Turkkan C, Ozcan KS, Ceylan US, Zengin A. The predictive value of PRECISE-DAPT score for arrhythmic complications in patients with ST-elevation myocardial infarction. Coronary Artery Disease. 2019 Nov 1;30(7):499-504.
  16. Ono M, Kawashima H, Hara H, Gamal A, Wang R, Gao C, O'Leary N, Soliman O, Piek JJ, van Geuns RJ, Jüni P, Hamm CW, Valgimigli M, Vranckx P, Windecker S, Steg PG, Fox KA, Onuma Y, Serruys PW. External validation of the GRACE risk score 2.0 in the contemporary all-comers GLOBAL LEADERS trial. Catheter CardiovascInterv. 2021 Oct;98(4): E513-E522. DOI: 10.1002/ccd.29772. Epub 2021 May 17. PMID: 34000088.
  17. Morrow DA, Antman EM, Charlesworth A, Cairns R, Murphy SA, de Lemos JA, Giugliano RP, McCabe CH, Braunwald E. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000 Oct 24;102(17):2031-7.
  18. Kim JY, Jeong MH, Ahn YK, Moon JH, Chae SC, Hur SH, Hong TJ, Kim YJ, Seong IW, Chae IH, Cho MC. Decreased glomerular filtration rate is an independent predictor of in-hospital mortality in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Korean Circulation Journal. 2011 Apr 1;41(4):184-90
  19. Zhao L, Wang L, Zhang Y. Elevated admission serum creatinine predicts poor myocardial blood flow and one-year mortality in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. The Journal of invasive cardiology. 2009 Oct 1;21(10):493-8.
  20. Feng QZ, Zhao YS, Li YF. Effect of haemoglobin concentration on the clinical outcomes in patients with acute myocardial infarction and the factors related to haemoglobin. BMC research notes. 2011 Dec;4(1):1-8.https://doi.org/10.1186/1756-0500-4-142
  21. Sabatine MS, Morrow DA, Giugliano RP, Burton PB, Murphy SA, McCabe CH, Gibson CM, Braunwald E. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes.Circulation. 2005 Apr 26;111(16):2042-9.
  22. Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM. The association between white blood cell count and acute myocardial infarction mortality in patients > or ¼65 years of age: findings from the cooperative cardiovascular project. J Am CollCardiol. 2001;38(6):1654-61.
  23. Long T, Peng L, Li F, Xia K, Jing R, Liu X, Xie Q, Yang T, Zhang C. Correlations of DAPT score and PRECISE-DAPT score with the extent of coronary stenosis in acute coronary syndrome. Medicine. 2018 Sep;97(39)
  24. Kaya MG, Arslan F, Abaci A, Heijden GV, Timurkay-Nak T, Cengel A. Myocardial blush grade: a predictor for major adverse cardiac events after primary PTCA with stent implantation for acute myocardial infarction. Actacardiologica. 2007 Oct 1;62(5):445-51.
Iranian Heart Journal
Volume 25, Issue 2
Spring 2024
Pages 35-46