Usefulness of the PARIS Score to Evaluate the Ischemic-hemorrhagic Net Benefit With Ticagrelor and Prasugrel After an Acute Coronary Syndrome

• Published in: Revista española de cardiología (English ed.) 2019-03, Vol.72 (3), p.215-223
• Main Authors: Raposeiras-Roubín, Sergio, Caneiro Queija, Berenice, D’Ascenzo, Fabrizio, Kinnaird, Tim, Ariza-Solé, Albert, Manzano-Fernández, Sergio, Templin, Christian, Velicki, Lazar, Xanthopoulou, Ioanna, Cerrato, Enrico, Quadri, Giorgio, Rognoni, Andrea, Boccuzzi, Giacome, Montabone, Andrea, Taha, Salma, Durante, Alessandro, Gili, Sebastiano, Magnani, Giulia, Autelli, Michele, Grosso, Alberto, Flores Blanco, Pedro, Garay, Alberto, Varbella, Ferdinando, Tomassini, Francesco, Cobas Paz, Rafael, Cespón Fernández, María, Muñoz Pousa, Isabel, Gallo, Diego, Morbiducci, Umberto, Domínguez-Rodríguez, Alberto, Baz-Alonso, José Antonio, Calvo-Iglesias, Francisco, Valdés, Mariano, Cequier, Ángel, Gaita, Fiorenzo, Alexopoulos, Dimitrios, Íñiguez-Romo, Andrés, Abu-Assi, Emad
• Format: Article
• Language: eng ; spa
• Subjects: Acute Coronary Syndrome - therapy; Aged; Cardiovascular; Dose-Response Relationship, Drug; Drug Therapy, Combination; Europe - epidemiology; Female; Follow-Up Studies; Hemorrhage - epidemiology; Hemorrhage - etiology; Humans; Incidence; Internal Medicine; Ischemia - epidemiology; Ischemia - etiology; Male; Middle Aged; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - administration & dosage; Platelet Aggregation Inhibitors - adverse effects; Prasugrel Hydrochloride - administration & dosage; Prasugrel Hydrochloride - adverse effects; Registries; Retrospective Studies; Risk Assessment - methods; Ticagrelor - administration & dosage; Ticagrelor - adverse effects; Treatment Outcome
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2018.06.004

Abstract Introduction and objectives The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry. Methods Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARISischemic and PARIShemorrhagic ). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events. Results During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARISischemic and PARIShemorrhagic scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk. Conclusions In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.