Department of Clinical and Experimental Medicine, Policlinic "G. Martino", University of Messina, Italy.
Erasmus University Medical Center, s-Gravendijkwal 230, Rotterdam, The Netherlands.
Am Heart J. 2020 May;223:44-47. doi: 10.1016/j.ahj.2020.01.014. Epub 2020 Jan 30.
The originally-proposed PRECISE-DAPT score is a 5-item risk score supporting decision-making for dual antiplatelet therapy 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]; p = 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]; p = 0.11). Only non-HBR patients experienced lower net clinical adverse events (NACE) with longer DAPT (p = 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.
最初提出的 PRECISE-DAPT 评分是一种 5 项风险评分，用于支持 PCI 后双联抗血小板治疗持续时间的决策。基于 4 个因素（年龄、血红蛋白、肌酐清除率、既往出血）且缺乏白细胞计数的简化版评分是否仍有可能指导 DAPT 持续时间尚不清楚。该 4 项 PRECISE-DAPT 评分用于对 10081 例患者进行分类，这些患者根据高出血风险（PRECISE-DAPT≥25 分定义的 HBR）或非高出血风险（PRECISE-DAPT<25）状态随机分为短期（3-6 个月）或长期（12-24 个月）DAPT 方案。在 HBR 患者中，较长的治疗持续时间与更高的出血率相关（ARD+2.22%[95%CI+0.53 至+3.90]），但在非 HBR 患者中则不然（ARD+0.25%[-0.14 至+0.64]；p=0.026），在非 HBR 患者中与较低的缺血风险相关（ARD-1.44%[95%CI-2.56 至-0.31]），但在 HBR 患者中则不然（ARD+1.16%[-1.91 至+4.22]；p=0.11）。只有非 HBR 患者在较长的 DAPT 治疗后，净临床不良事件（NACE）发生率更低（p=0.043）。PRECISE-DAPT 评分的 4 项简化版保留了区分那些受益于延长 DAPT 而无出血风险的患者和那些无受益的患者的潜力。
