Dafaalla Mohamed, Costa Francesco, Kontopantelis Evangelos, Bagur Rodrigo, Iannaccone Mario, Bironzo Paolo, Roubí Sergio Raposeiras, De Filippo Ovidio, D'Ascenzo Fabrizio, Mamas Mamas A
Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK.
Cardiology Department, University Hospital Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
Catheter Cardiovasc Interv. 2025 Sep;106(3):1912-1919. doi: 10.1002/ccd.70040. Epub 2025 Jul 22.
We aimed to externally validate the PRECISE-DAPT cancer score which showed better accuracy in predicting bleeding events in patients with cancer than the original PRECISE-DAPT score.
We used data from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) project. We compared the performance and clinical usefulness of the original score and the cancer score by calculating the C-statistic, the net reclassification index (NRI), and decision curve analysis.
A total of 13,932 patients were included, of which 864 patients had a diagnosis of cancer at the time of presentation with an AMI. According to the original PRECISE DAPT score, 63.3% of patients with cancer were classified as HBR, whereas 94.9% of patients with cancer were classified as HBR according to the cancer score. Cox-regression models showed that patients classified as HBR by the updated cancer score have higher odds of bleeding (HR 2.6, 95% CI 2.1-3.1) events than patients classified as HBR by the original score (HR 2.2, 95% CI 1.8-2.7). The cancer score showed higher discrimination ability (C-statistic 0.66) than the original score (C-statistic 0.64). The overall NRI of the cancer score was 2.7%. The decision curves analysis showed that the cancer score use is roughly identical to the original score in patients without cancer but superior to the original score in patients with cancer.
The PRECISE-DAPT cancer score is a valid and useful tool for the prediction of bleeding risk in patients with cancer and presenting with AMI.
我们旨在对PRECISE-DAPT癌症评分进行外部验证，该评分在预测癌症患者出血事件方面比原始的PRECISE-DAPT评分具有更高的准确性。
我们使用了来自BleeMACS（急性冠状动脉综合征后出院患者多中心登记处的出血并发症）项目的数据。我们通过计算C统计量、净重新分类指数（NRI）和决策曲线分析，比较了原始评分和癌症评分的性能及临床实用性。
共纳入13932例患者，其中864例患者在出现急性心肌梗死时被诊断为癌症。根据原始的PRECISE DAPT评分，63.3%的癌症患者被归类为高出血风险（HBR），而根据癌症评分，94.9%的癌症患者被归类为HBR。Cox回归模型显示，根据更新后的癌症评分被归类为HBR的患者发生出血事件的几率（HR 2.6，95%CI 2.1 - 3.1）高于根据原始评分被归类为HBR的患者（HR 2.2，95%CI 1.8 - 2.7）。癌症评分显示出比原始评分更高的鉴别能力（C统计量0.66）（原始评分C统计量0.64）。癌症评分的总体NRI为2.7%。决策曲线分析表明，癌症评分在无癌症患者中的使用与原始评分大致相同，但在癌症患者中优于原始评分。
PRECISE-DAPT癌症评分是预测癌症合并急性心肌梗死患者出血风险的有效且有用的工具。
