Early bleeding risk prediction with the PRECISE-HBR score in PCI patients treated with cangrelor: the ICARUS registry
V De Sio, F Gragnano, S Benenati, R Scalamera, A Capolongo, A Cesaro, E Moscarella, L De Luca, G Galasso, A Menozzi, G Musumeci, P L Cirillo, M Valgimigli, I Porto, P Calabro'Abstract
Background
Cangrelor is recommended for the prevention of periprocedural thrombotic events in P2Y12 inhibitor-naïve patients undergoing percutaneous coronary intervention (PCI). Bleeding risk scores have not been definitely validated in cangrelor-treated patients.
Aim
We assessed the performance of the PRECISE-HBR score in PCI patients receiving cangrelor.
Methods
Consecutive patients undergoing PCI with cangrelor enrolled in the ICARUS registry were analyzed to assess the ability of the PRECISE-HBR score in predicting Bleeding Academic Research Consortium (BARC) type 2-5 bleeding within 48 hours. The associations between the PRECISE-HBR score and 48-hour BARC 2-5 bleeding and net adverse clinical events (NACE) were also assessed.
Results
Among 1,067 patients undergoing PCI with cangrelor, the PRECISE-HBR score demonstrated modest discrimination (c-statistic 0.66, 95% CI 0.58-0.73) in predicting BARC 2-5 bleeding at 48 hours. The score classified 442 patients (41.4%) at high bleeding risk (HBR) (score ≥23). At 48 hours, BARC 2-5 bleeding (7.9% vs. 2.9%; odds ratio [OR] 2.91, 95% CI 1.63-5.21, p<0.001) and NACE (9.8% vs. 3.8%; OR 2.71, 95% CI 1.62-4.53, p<0.001) were more frequent in HBR than in non-HBR patients. Natural spline analyses showed a consistent, graded association between the PRECISE-HBR score and the risk of BARC 2-5 bleeding and NACE at 48 hours.
Conclusions
Among patients undergoing PCI treated with cangrelor, the PRECISE-HBR score identified 41% of patients at HBR and showed modest ability in predicting early bleeding. The PRECISE-HBR score was associated with BARC 2-5 bleeding and NACE at 48 hours, which supports its role for early risk stratification in this setting.AUC PRECISE-HBR scoreFor image description, please refer to the figure legend and surrounding text.Spline functionFor image description, please refer to the figure legend and surrounding text.