Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?
Background and aims Due to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was created to facilitate the use of risk stratification. We aimed to compare the...
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| Format: | Article |
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BMJ Publishing Group
2025-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003083.full |
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| author | Pascal Vranckx Stephan Windecker Marco Valgimigli Neil O’Leary Yoshinobu Onuma Peter Damman Eva Christine Ida Woelders Kai Ninomiya Denise Adriana Maria Peeters Arnoud Willem Johannes van 't Hof Patrick Washington J C Serruys Robert-Jan Matthijs van Geuns |
| author_facet | Pascal Vranckx Stephan Windecker Marco Valgimigli Neil O’Leary Yoshinobu Onuma Peter Damman Eva Christine Ida Woelders Kai Ninomiya Denise Adriana Maria Peeters Arnoud Willem Johannes van 't Hof Patrick Washington J C Serruys Robert-Jan Matthijs van Geuns |
| author_sort | Pascal Vranckx |
| collection | DOAJ |
| description | Background and aims Due to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was created to facilitate the use of risk stratification. We aimed to compare the predictive and prognostic value of the ‘Zuidoost Nederland Hart Registratie’ (ZON-HR) classification for bleeding risk with the PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent DAPT (PRECISE-DAPT) score and to determine the effect of ticagrelor monotherapy versus DAPT in patients with or without high bleeding risk (HBR).Methods A post hoc analysis of the GLOBAL LEADERS trial was performed to compare the predictive value of the ZON-HR classification with the PRECISE-DAPT score. Also, the outcomes stratified by either method were compared and the interaction of HBR on the treatment effect was determined.Results The required parameters for the ZON-HR classification (3.7% HBR) and PRECISE-DAPT score (16.6% HBR) were available in 99.9% and 93% of the patients, respectively. The ZON-HR classification had a lower sensitivity (0.09 vs 0.26) and a higher specificity (0.97 vs 0.84), positive predictive value (0.13 vs 0.08) and accuracy (0.92 vs 0.82). Regression analysis showed that both methods predicted hazard for bleeding risk with HRs of 1.87 (95% CI: 1.59 to 2.18) and 2.67 (95% CI: 2.10 to 3.41) for the PRECISE-DAPT score and ZON-HR classification, respectively. The omission of aspirin reduced bleeding events only in acute coronary syndrome (ACS) patients without HBR (HR: 0.74, 95% CI: 0.61 to 0.90, p value for interaction of HBR: 0.04).Conclusions Stratification for bleeding risk according to the ZON-HR classification was feasible in almost all patients and showed to be more conservative than the PRECISE-DAPT score with a consistent prognostic accuracy. The benefit of aspirin omission was the largest in ACS patients without HBR.Trial registration number NCT01813435. |
| format | Article |
| id | doaj-art-eaea47120e394d6ba36208813ba5e881 |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-eaea47120e394d6ba36208813ba5e8812025-01-29T05:55:08ZengBMJ Publishing GroupOpen Heart2053-36242025-01-0112110.1136/openhrt-2024-003083Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy?Pascal Vranckx0Stephan Windecker1Marco Valgimigli2Neil O’Leary3Yoshinobu Onuma4Peter Damman5Eva Christine Ida Woelders6Kai Ninomiya7Denise Adriana Maria Peeters8Arnoud Willem Johannes van 't Hof9Patrick Washington J C Serruys10Robert-Jan Matthijs van Geuns11Department of Cardiology and Critical Care Medicine, Jessa Ziekenhuis, Hasselt University, Hasselt, BelgiumDepartment of Cardiology, Inselspital, University of Bern, Bern, SwitzerlandCardiocentro Ticino, Lugano, SwitzerlandSchool of Mathematical and Statistical Sciences, University of Galway, Galway, IrelandDepartment of Cardiology, University of Galway, Galway, IrelandCardiology, Radboudumc, Nijmegen, The NetherlandsCardiology, Radboudumc, Nijmegen, The NetherlandsDepartment of Cardiology, University of Galway, Galway, IrelandCardiology, Radboudumc, Nijmegen, The NetherlandsCardiology, Maastricht University Medical Centre+, Maastricht, The NetherlandsDepartment of Cardiology, University of Galway, Galway, IrelandCardiology, Radboudumc, Nijmegen, The NetherlandsBackground and aims Due to the multitude of risk factors outlined in the guidelines, personalised dual antiplatelet therapy (DAPT) guidance after percutaneous coronary intervention (PCI) is complex. A simplified method was created to facilitate the use of risk stratification. We aimed to compare the predictive and prognostic value of the ‘Zuidoost Nederland Hart Registratie’ (ZON-HR) classification for bleeding risk with the PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent DAPT (PRECISE-DAPT) score and to determine the effect of ticagrelor monotherapy versus DAPT in patients with or without high bleeding risk (HBR).Methods A post hoc analysis of the GLOBAL LEADERS trial was performed to compare the predictive value of the ZON-HR classification with the PRECISE-DAPT score. Also, the outcomes stratified by either method were compared and the interaction of HBR on the treatment effect was determined.Results The required parameters for the ZON-HR classification (3.7% HBR) and PRECISE-DAPT score (16.6% HBR) were available in 99.9% and 93% of the patients, respectively. The ZON-HR classification had a lower sensitivity (0.09 vs 0.26) and a higher specificity (0.97 vs 0.84), positive predictive value (0.13 vs 0.08) and accuracy (0.92 vs 0.82). Regression analysis showed that both methods predicted hazard for bleeding risk with HRs of 1.87 (95% CI: 1.59 to 2.18) and 2.67 (95% CI: 2.10 to 3.41) for the PRECISE-DAPT score and ZON-HR classification, respectively. The omission of aspirin reduced bleeding events only in acute coronary syndrome (ACS) patients without HBR (HR: 0.74, 95% CI: 0.61 to 0.90, p value for interaction of HBR: 0.04).Conclusions Stratification for bleeding risk according to the ZON-HR classification was feasible in almost all patients and showed to be more conservative than the PRECISE-DAPT score with a consistent prognostic accuracy. The benefit of aspirin omission was the largest in ACS patients without HBR.Trial registration number NCT01813435.https://openheart.bmj.com/content/12/1/e003083.full |
| spellingShingle | Pascal Vranckx Stephan Windecker Marco Valgimigli Neil O’Leary Yoshinobu Onuma Peter Damman Eva Christine Ida Woelders Kai Ninomiya Denise Adriana Maria Peeters Arnoud Willem Johannes van 't Hof Patrick Washington J C Serruys Robert-Jan Matthijs van Geuns Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? Open Heart |
| title | Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? |
| title_full | Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? |
| title_fullStr | Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? |
| title_full_unstemmed | Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? |
| title_short | Parsimonious versus extensive bleeding score: can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de-escalation of the antiplatelet strategy? |
| title_sort | parsimonious versus extensive bleeding score can we simplify risk stratification after percutaneous coronary intervention and reduce bleeding events by de escalation of the antiplatelet strategy |
| url | https://openheart.bmj.com/content/12/1/e003083.full |
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