Paired risk scores to predict ischaemic and bleeding risk twenty-eight days to one year after an acute coronary syndrome
Authors' conclusion
We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.
Study context
- Population
- New Zealand (NZ) patients aged 18–84 years with acute coronary syndrome (ACS) investigated with coronary angiography (2012–2020), event free at 28 days postdischarge, without AF
- Participants
- 27,755 patients
- Exposure
- Ischaemic score vs Bleeding score
- Outcome
- Ischaemic events (CV mortality/rehospitalisation with MI or ischaemic stroke) and major bleeding events (bleeding mortality/rehospitalisation with bleeding)
- Follow-up
- 28 days to 1 year postdischarge
Methodological detailsregistry cohort, registry-based, linked national health datasets
- Registry cohort
- Registry-based
- Linked national health datasets
Main finding
As reported in the abstract
Discrimination of the 28-day to 1-year risk scores (Harrell's c-statistic)
Ischaemic events
1200
4.3%
Major bleeding events
548
2.0%
Observational data: associations, not effects.
Further findings
Risk categories applying the scores to the 2020 ESC ACS antithrombotic algorithm
- Elevated (>2%) bleeding and ischaemic risk: abbreviated DAPT considered
- 31%
- Low bleeding, elevated ischaemic risk: prolonged DAPT may be appropriate
- 37%
- Low bleeding and ischaemic risk: short DAPT may be justified
- 29%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Paired risk scores to predict ischaemic and bleeding risk twenty-eight days to one year after an acute coronary syndrome. Heart. Published 9 August 2023. doi:10.
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