A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making.

Costa, Francesco; van Klaveren, David; Colombo, Antonio; Feres, Fausto; Räber, Lorenz; Pilgrim, Thomas; Hong, Myeong-Ki; Kim, Hyo-Soo; Windecker, Stephan; Steyerberg, Ewout W; Valgimigli, Marco (2020). A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making. American Heart Journal, 223, pp. 44-47. Elsevier 10.1016/j.ahj.2020.01.014

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The originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy1 duration after PCI. It is unknown if a simplified version of the score based on 4 factors (age, hemoglobin, creatinine clearance, prior bleeding), and lacking white-blood cell count, retains potential to guide DAPT duration. The 4-item PRECISE-DAPT was used to categorize 10,081 patients who were randomized to short (3-6 months) or long (12-24 months) DAPT regimen according to high (HBR defined by PRECISE-DAPT ≥25 points) or non-high bleeding risk (PRECISE-DAPT<25) status. Long treatment duration was associated with higher bleeding rates in HBR (ARD +2.22% [95% CI +0.53 to +3.90]) but not in non-HBR patients (ARD +0.25% [-0.14 to +0.64]; pint = 0.026), and associated with lower ischemic risks in non-HBR (ARD -1.44% [95% CI -2.56 to -0.31]), but not in HBR patients (ARD +1.16% [-1.91 to +4.22]; pint = 0.11). Only non-HBR patients experienced lower net clinical adverse events (NACE) with longer DAPT (pint = 0.043). A 4-item simplified version of the PRECISE-DAPT score retains the potential to categorize patients who benefit from prolonged DAPT without concomitant bleeding liability from those who do not.

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