Enström Philip, Martinsson Andreas, Rezk Mary, Nielsen Susanne, Björklund Erik, Landenhed-Smith Maya, Pan Emily, Jeppsson Anders
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg 41345, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg 41124, Sweden.
Eur Heart J Cardiovasc Pharmacother. 2025 Feb 8;11(1):48-56. doi: 10.1093/ehjcvp/pvae060.
Early identification of patients with increased bleeding risk increases the possibility to individualize antithrombotic treatment. We validated the PRECISE-DAPT score, originally developed to estimate bleeding risk in patients on dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI), in coronary artery bypass grafting (CABG) patients.
All patients who underwent the first time, isolated CABG in Sweden 2009-2020 and survived until discharge were included. The four-item PRECISE-DAPT score, based on age, estimated glomerular filtration rate, pre-operative haemoglobin concentration, and previous spontaneous bleeding, was calculated in patients discharged on DAPT (n = 6838), or antiplatelet monotherapy (n = 15 406). High bleeding risk was defined as a score ≥25 in accordance with previous studies and major bleeding as hospitalization due to bleeding. Associations were assessed by C-statistics and Cox regression models. Major bleeding occurred during the first post-operative year in 130 patients (1.9%) in the DAPT group, and in 197 patients (1.3%) in the monotherapy group. The score identified 32.9% of the patients in the DAPT group and 38.2% in the monotherapy groups as having high bleeding risk. The area under the ROC-curve for the score was 0.67 (95%CI 0.62-0.72) for DAPT and 0.71 (0.67-0.74) for monotherapy. The hazard ratio for high bleeding risk vs. very low risk was 4.14 (2.07-8.26) for DAPT patients, and 4.95 (2.61-9.39) for monotherapy patients, both P < 0.001.
The PRECISE-DAPT identifies patients with increased risk for major bleeding after discharge following CABG with moderate accuracy. The accuracy is comparable to what previously has been reported for patients after PCI.
早期识别出血风险增加的患者可提高抗栓治疗个体化的可能性。我们在冠状动脉旁路移植术（CABG）患者中验证了最初用于评估经皮冠状动脉介入治疗（PCI）后接受双联抗血小板治疗（DAPT）患者出血风险的PRECISE-DAPT评分。
纳入2009年至2020年在瑞典首次接受单纯CABG且存活至出院的所有患者。在接受DAPT出院的患者（n = 6838）或抗血小板单药治疗出院的患者（n = 15406）中计算基于年龄、估计肾小球滤过率、术前血红蛋白浓度和既往自发性出血情况的四项PRECISE-DAPT评分。根据既往研究，高出血风险定义为评分≥25，大出血定义为因出血住院。通过C统计量和Cox回归模型评估相关性。DAPT组130例患者（1.9%）和单药治疗组197例患者（1.3%）在术后第一年发生大出血。该评分在DAPT组中识别出32.9%的患者以及在单药治疗组中识别出38.2%的患者具有高出血风险。DAPT评分的ROC曲线下面积为0.67（95%CI 0.62 - 0.72），单药治疗为0.71（0.67 - 0.74）。DAPT患者高出血风险与极低出血风险的风险比为4.14（2.07 - 8.26），单药治疗患者为4.95（2.61 - 9.39），两者P均<0.001。
PRECISE-DAPT评分对CABG术后出院患者大出血风险增加的识别具有中等准确性。该准确性与之前报道的PCI术后患者相当。
