Performance of the REACH, PARIS, BleeMACS, and PRECISE-DAPT scores for predicting 1-year bleeding events in patients undergoing coronary drug-eluting stent implantation

• Published in: Platelets (Edinburgh) 2022-07, Vol.33 (5), p.719-726
• Main Authors: Lyu, Si-Qi, Zhu, Jun, Wang, Juan, Wu, Shuang, Zhang, Han, Shao, Xing-Hui, Yang, Yan-min
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - etiology; Bleeding risk scores; coronary drug-eluting stent implantation; Drug Therapy, Combination; Drug-Eluting Stents - adverse effects; Hemorrhage - etiology; Humans; Percutaneous Coronary Intervention - adverse effects; Platelet Aggregation Inhibitors - adverse effects; predictive performance; Risk Assessment; the PRECISE-DAPT score; Treatment Outcome
• ISSN: 0953-7104; 1369-1635
• DOI: 10.1080/09537104.2021.1981847

This study aimed to evaluate the predictive performance of the REACH, PARIS, BleeMACS, and PRECISE-DAPT scores in Chinese patients undergoing coronary drug-eluting stent (DES) implantation. A total of 1911 patients undergoing coronary DES implantation were consecutively recruited and followed up for 1 year. The primary endpoints were BARC type 3 or 5 bleeding and BARC type 2,3, or 5 bleeding. The BleeMACS score and the PRECISE-DAPT score were significantly associated with 1-year incidence of BARC type 3 or 5 bleeding, but not BARC type 2, 3, or 5 bleeding. The discrimination of the PRECISE-DAPT score was moderate for BARC type 3 or 5 bleeding (c-statistic = 0.633), while those of the REACH (c-statistic = 0.533), PARIS (c-statistic = 0.553), and BleeMACS scores (c-statistic = 0.613) were relatively low. However, the analysis of c-statistic, NRI, and IDI detected no significant discrimination improvement of the PRECISE-DAPT score for BARC type 3 or 5 bleeding compared to the other three scores. The calibrations of the PRECISE-DAPT and BleeMACS scores were modest (Hosmer-Lemeshow test p > .05). Decision curve analysis indicated net benefit of the PRECISE-DAPT score in bleeding risk evaluation. In conclusion, the PRECISE-DAPT score performed moderately in predicting BARC type 3 or 5 bleeding, while the discriminative capacities of the REACH, PARIS, BleeMACS scores were relatively low in patients undergoing DES implantation. But no significant discrimination improvement of the PRECISE-DAPT score compared to the other scores could be detected. Further studies are required to develop standardized bleeding risk scores for this population.