External validity of the PRECISE-DAPT score in patients undergoing PCI: a systematic review and meta-analysis

Eur Heart J Cardiovasc Pharmacother. 2023 Aug 26:pvad063. doi: 10.1093/ehjcvp/pvad063. Online ahead of print.


Aims: To summarise the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets.

Methods and results: We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratio (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of twenty-one studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high-bleeding risk (PRECISE-DAPT ≥ 25) and when compared to those at low-bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24-3.29; p-value < 0.001) and major bleedings (OR: 3.51; 95% CI: 2.71-4.55; p-value < 0.001). Pooling data on c-stat whenever available, the PRECISE-DAPT score showed a moderate discriminative power in predicting major bleeding events at 1-year (pooled c-stat: 0.71; 95% CI: 0.64-0.77).

Conclusion: This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.

Keywords: Acute coronary syndrome; Bleeding risk; Dual antiplatelet therapy; Percutaneous coronary intervention.