Bleeding Risk Prediction After Acute Myocardial Infarction-integrating Cancer Data: the Updated PRECISE-DAPT Cancer Score

Overview

Journal Eur Heart J

Publisher Oxford University Press

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 17

PMID 39016180

Authors

Mohamed Dafaalla

Francesco Costa

Evangelos Kontopantelis

Mario Araya

Tim Kinnaird

Antonio Micari

Haibo Jia

Gary S Mintz

Mamas A Mamas

Affiliations

Soon will be listed here.

Abstract

Background And Aims: This study assessed the impact of incorporating cancer as a predictor on performance of the PRECISE-DAPT score.

Methods: A nationally linked cohort of ST-elevation myocardial infarction patients between 1 January 2005 and 31 March 2019 was derived from the UK Myocardial Ischaemia National Audit Project and the UK Hospital Episode Statistics Admitted Patient Care registries. The primary outcome was major bleeding at 1 year. A new modified score was generated by adding cancer as a binary variable to the PRECISE-DAPT score using a Cox regression model and compared its performance to the original PRECISE-DAPT score.

Results: A total of 216 709 ST-elevation myocardial infarction patients were included, of which 4569 had cancer. The original score showed moderate accuracy (C-statistic .60), and the modified score showed modestly higher discrimination (C-statistics .64; hazard ratio 1.03, 95% confidence interval 1.03-1.04) even in patients without cancer (C-statistics .63; hazard ratio 1.03, 95% confidence interval 1.03-1.04). The net reclassification index was .07. The bleeding rates of the modified score risk categories (high, moderate, low, and very low bleeding risk) were 6.3%, 3.8%, 2.9%, and 2.2%, respectively. According to the original score, 65.5% of cancer patients were classified as high bleeding risk (HBR) and 21.6% were low or very low bleeding risk. According to the modified score, 94.0% of cancer patients were HBR, 6.0% were moderate bleeding risk, and no cancer patient was classified as low or very low bleeding risk.

Conclusions: Adding cancer to the PRECISE-DAPT score identifies the majority of patients with cancer as HBR and can improve its discrimination ability without undermining its performance in patients without cancer.

References

Munafo A, Montalto C, Franzino M, Pistelli L, Di Bella G, Ferlini M . External validity of the PRECISE-DAPT score in patients undergoing PCI: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2023; 9(8):709-721. DOI: 10.1093/ehjcvp/pvad063. View

Mamas M, Kwok C, Kontopantelis E, Fryer A, Buchan I, Bachmann M . Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry. J Am Heart Assoc. 2016; 5(11). PMC: 5210321. DOI: 10.1161/JAHA.116.003348. View

Dafaalla M, Abdel-Qadir H, Gale C, Sun L, Lopez-Fernandez T, Miller R . Outcomes of ST elevation myocardial infarction in patients with cancer: a nationwide study. Eur Heart J Qual Care Clin Outcomes. 2023; 9(8):806-817. DOI: 10.1093/ehjqcco/qcad012. View

Coles B, Teece L, Weston C, de Belder M, Oliver-Williams C, Welch C . Case-ascertainment of acute myocardial infarction hospitalizations in cancer patients: a cohort study using English linked electronic health data. Eur Heart J Qual Care Clin Outcomes. 2021; 8(1):86-95. PMC: 8728035. DOI: 10.1093/ehjqcco/qcab045. View

Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F . Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet. 2017; 389(10073):1025-1034. DOI: 10.1016/S0140-6736(17)30397-5. View

Baber U, Mehran R, Giustino G, Cohen D, Henry T, Sartori S . Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents: Risk Scores From PARIS. J Am Coll Cardiol. 2016; 67(19):2224-2234. DOI: 10.1016/j.jacc.2016.02.064. View

Castelijns M, Hageman S, Teraa M, van der Meer M, Westerink J, Costa F . External validation of bleeding risk models for the prediction of long-term bleeding risk in patients with established cardiovascular disease. Am Heart J. 2023; 260:72-81. DOI: 10.1016/j.ahj.2023.02.011. View

Rashid Hons M, Gale Hons C, Curzen Hons N, Ludman Hons P, De Belder Hons M, Timmis Hons A . Impact of Coronavirus Disease 2019 Pandemic on the Incidence and Management of Out-of-Hospital Cardiac Arrest in Patients Presenting With Acute Myocardial Infarction in England. J Am Heart Assoc. 2020; 9(22):e018379. PMC: 7763705. DOI: 10.1161/JAHA.120.018379. View

Valgimigli M, Frigoli E, Heg D, Tijssen J, Juni P, Vranckx P . Dual Antiplatelet Therapy after PCI in Patients at High Bleeding Risk. N Engl J Med. 2021; 385(18):1643-1655. DOI: 10.1056/NEJMoa2108749. View

10.

Mehran R, Rao S, Bhatt D, Gibson C, Caixeta A, Eikelboom J . Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011; 123(23):2736-47. DOI: 10.1161/CIRCULATIONAHA.110.009449. View

11.

Rashid M, Wu J, Timmis A, Curzen N, Clarke S, Zaman A . Outcomes of COVID-19-positive acute coronary syndrome patients: A multisource electronic healthcare records study from England. J Intern Med. 2021; 290(1):88-100. PMC: 8013521. DOI: 10.1111/joim.13246. View

12.

Giri J, Nathan A . The Pros and Cons of Percutaneous Coronary Intervention in Patients With Cancer. JACC CardioOncol. 2021; 1(2):156-158. PMC: 8352212. DOI: 10.1016/j.jaccao.2019.11.002. View

13.

Bharadwaj A, Swamy P, Mamas M . Outcomes of percutaneous coronary interventions in cancer patients. Expert Rev Cardiovasc Ther. 2020; 18(1):25-32. DOI: 10.1080/14779072.2020.1718493. View

14.

Costa F, van Klaveren D, Colombo A, Feres F, Raber L, Pilgrim T . A 4-item PRECISE-DAPT score for dual antiplatelet therapy duration decision-making. Am Heart J. 2020; 223:44-47. DOI: 10.1016/j.ahj.2020.01.014. View

15.

Rashid M, Curzen N, Kinnaird T, Lawson C, Myint P, Kontopantelis E . Baseline risk, timing of invasive strategy and guideline compliance in NSTEMI: Nationwide analysis from MINAP. Int J Cardiol. 2019; 301:7-13. DOI: 10.1016/j.ijcard.2019.11.146. View

16.

Velders M, Hagstrom E, James S . Temporal Trends in the Prevalence of Cancer and Its Impact on Outcome in Patients With First Myocardial Infarction: A Nationwide Study. J Am Heart Assoc. 2020; 9(4):e014383. PMC: 7070202. DOI: 10.1161/JAHA.119.014383. View

17.

Dafaalla M, Rashid M, Bond R, Smith T, Parwani P, Thamman R . Racial Disparities in Management and Outcomes of Out-of-Hospital Cardiac Arrest Complicating Myocardial Infarction: A National Study From England and Wales. CJC Open. 2022; 3(12 Suppl):S81-S88. PMC: 8712673. DOI: 10.1016/j.cjco.2021.09.026. View

18.

Collet J, Thiele H, Barbato E, Barthelemy O, Bauersachs J, Bhatt D . 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; 42(14):1289-1367. DOI: 10.1093/eurheartj/ehaa575. View

19.

Birkhead J, Weston C, Chen R . Determinants and outcomes of coronary angiography after non-ST-segment elevation myocardial infarction. A cohort study of the Myocardial Ischaemia National Audit Project (MINAP). Heart. 2009; 95(19):1593-9. DOI: 10.1136/hrt.2008.164426. View

20.

Urban P, Mehran R, Colleran R, Angiolillo D, Byrne R, Capodanno D . Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Eur Heart J. 2019; 40(31):2632-2653. PMC: 6736433. DOI: 10.1093/eurheartj/ehz372. View