Coronary disease & ACSCohort study
Discordance and Performance of the ARC-HBR and PRECISE-DAPT High Bleeding Risk Definitions After Coronary Stenting
- Retrospective cohort study
- nationwide registers
Authors' conclusion
There was substantial discordance in the categorization of high bleeding risk between the ARC-HBR definition and the PRECISE-DAPT score. Both tools identified patients at increased bleeding risk, but those patients also had increased ischemic risk. The PRECISE-DAPT score underestimated bleeding risk.
Study context
- Population
- Patients discharged after coronary stenting with DAPT, Stockholm, Sweden, 2013–2018
- Participants
- 7,562 patients
- Exposure
- ARC-HBR vs PRECISE-DAPT high bleeding risk definitions
- Outcome
- Bleeding (BARC types 3-5 or TIMI major or minor) and ischemic events (MI or ischemic stroke)
- Follow-up
- 1 year after discharge
Main finding
As reported in the abstract
Categorization as high bleeding risk
- Discordant HBR categorization between the 2 tools
- 22% (1,696 of 7,562)
Observational data: associations, not effects.
Further findings
| Outcome | ARC-HBR | PRECISE-DAPT | HR (95% CI) | |
|---|---|---|---|---|
| BARC type 3 to 5 bleeding, ARC-HBR · 1 year | 7.1% | Not reported in the abstract | 3.21 (2.47–4.17) | |
| Ischemic events, ARC-HBR · 1 year | 7.8% | Not reported in the abstract | 2.96 (2.31–3.79) | |
| TIMI major or minor bleeding, PRECISE-DAPT · 1 year | Not reported in the abstract | 4.4% | 2.17 (1.63–2.89) | |
| Ischemic events, PRECISE-DAPT · 1 year | Not reported in the abstract | 6.2% | 2.38 (1.85–3.05) | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | median absolute difference |
|---|---|
| PRECISE-DAPT calibration: observed vs predicted 1-year bleeding risk · Q1-Q3: 0.8%-1.4% | 1.1% |
- BARC type 3 to 5 bleeding, ARC-HBR: ARC-HBR non-HBR 2.3%
- Ischemic events, ARC-HBR: ARC-HBR non-HBR 2.8%
- TIMI major or minor bleeding, PRECISE-DAPT: PRECISE-DAPT non-HBR 2.1%
- Ischemic events, PRECISE-DAPT: PRECISE-DAPT non-HBR 2.7%
PRECISE-DAPT calibration: observed vs predicted 1-year bleeding risk
- PRECISE-DAPT underestimated bleeding risk across almost all score levels
Original publication
Discordance and Performance of the ARC-HBR and PRECISE-DAPT High Bleeding Risk Definitions After Coronary Stenting. JACC Cardiovasc Interv. Published 22 January 2025. doi:10.1016/j.jcin.2024.10.032
Summarised from the published abstract; every number is checked against it