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Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo)

https://doi.org/10.20996/1819-6446-2019-15-6-806-812

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Abstract

Aim. We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.

Material and methods. The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.

Results. The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.

Conclusion. In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.

About the Authors

D. Yu. Sedykh
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
Russian Federation

Darya Yu. Sedykh – MD, PhD, Researcher, Laboratory of Pathophysiology, Department of Multivessel Coronary Artery Disease and Polyvascular Disease, Research Institute for Complex Issues of Cardiovascular Diseases; Cardiologist, Kemerovo Regional Cardiology Dispensary

Sosnoviy bulv. 6, Kemerovo, 650002



V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation

Vasiliy V. Kashtalap – MD, PhD, Head of Laboratory of Pathophysiology, Department of Multivessel Coronary Artery Disease and Polyvascular Disease, Research Institute for Complex Issues of Cardiovascular Diseases; Associate Professor, Chair of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University

Sosnoviy bulv. 6, Kemerovo, 650002, 

Voroshilova ul. 22A, Kemerovo, 650029



R. M. Velieva
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
Russian Federation

Rufana M. Velieva – Postgraduate Student, Research Institute for Complex Issues of Cardiovascular Diseases; Cardiologist, Kemerovo Regional Cardiology Dispensary

Sosnoviy bulv. 6, Kemerovo, 650002



O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation

Olga L. Barbarash – MD, PhD, Corresponding Member of the Russian Academy of Sciences, Director, Research Institute for Complex Issues of Cardiovascular Diseases; Head of Chair of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University 

Sosnoviy bulv. 6, Kemerovo, 650002, 

Voroshilova ul. 22A, Kemerovo, 650029



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For citation:


Sedykh D.Y., Kashtalap V.V., Velieva R.M., Barbarash O.L. Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo). Rational Pharmacotherapy in Cardiology. 2019;15(6):806-812. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-6-806-812

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)