PRECISE-DAPT Score fails to predict clinically relevant bleeding in elderly patients with ACS
C Costa, I C Ines Cruz, T A Tiago Aguiar, M S Mariana Silva, M B Mesquita BastosAbstract
Background
The PRECISE-DAPT score has demonstrated utility in predicting hemorrhagic events associated with dual antiplatelet therapy (DAPT) and in guiding therapy duration in patients with Acute Coronary Syndrome (ACS). However, its predictive accuracy in older adults, a population characterized by increasing ACS prevalence and elevated baseline bleeding risk, remains uncertain.
Objective
To assess the predictive performance of the PRECISE-DAPT score for clinically significant bleeding in patients aged >75 years receiving DAPT after ACS.
Methods
A retrospective cohort study was conducted including patients aged ≥75 years admitted with ACS between January 2020 and December 2024. Patients with prior DAPT exposure or discharged on oral anticoagulation were excluded. Clinical and laboratory variables required for PRECISE-DAPT calculation—history of prior bleeding, baseline hemoglobin, leukocyte count, and estimated glomerular filtration rate—were collected at discharge. The primary endpoint was BARC (Bleeding Academic Research Consortium) grade ≥ 2 bleeding, defined as requiring at least medical intervention, occurring during the course of DAPT. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis.
Results
A total of 402 patients (74% male; mean age 80 ± 4 years) were included. Most (92%) received aspirin plus clopidogrel. During a mean follow-up of 9 ± 4 months, 61 patients (18.7%) experienced BARC ≥2 bleeding. PRECISE-DAPT scores were similar in patients with and without bleeding (34 ± 10 vs 32 ± 7; p = 0.54). The proportion classified as high risk (score > 25) was comparably high in both groups and even within this high-risk category the score displayed no discriminative ability (81% vs. 76%; p = 0.48). No significant differences were observed in any individual score components. Overall, the score demonstrated poor discriminatory performance, with an AUC of 0.519.
Conclusions
Among patients aged ≥ 75 years with ACS, the PRECISE-DAPT score demonstrated minimal ability to predict clinically relevant bleeding during DAPT. Accordingly, the score should not be used in isolation to guide DAPT duration in this population but rather integrated with individualized clinical judgment and geriatric-specific bleeding risk stratification tools