Predictors of dual antiplatelet therapy related bleeding complications in elderly patients after coronary stenting: a multi-center retrospective observation
Objective: To study the independent predictors of major bleeding events and assess the performance of PRECISE-DAPT score in the elderly patients 75 years with one-year dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Methods: A total of 940 coronary artery disease (CAD) patients of age 75 years receiving one-year DAPT following PCI were retrospectively enrolled in the study. The main outcome was the incidence of bleeding complications within one year after discharge. Multivariate logistic regression analysis was conducted to investigate independent predictors of antiplatelet-related bleeding complications. Receiver operating characteristic (ROC) curve analysis was performed to obtain the optimized PRECISE-DAPT score in elderly patients after PCI. Results: A total of 89 (9.47%) patients suffered from bleeding complications among 940 patients. Of which, 37 (3.94%) had BARC 2 and 52 (5.53%) had BARC <2 type bleeding events. We stratified PRECISE-DAPT score in tertiles (T1: <24; T2: 24 to 32; T3: >32) and found that major bleeding (defined as BARC 2 type) occurred more frequently in T3 than T1 and T2 (8.25% vs. 1.46% vs. 2.40%, P<0.05). The ROC analysis revealed that the cut-off value of PRECISE-DAPT score for major bleeding prediction was 33. Multivariate logistic regression analysis demonstrated that PRECISE-DAPT score 32 (OR: 3.373; 95%CI (1.093, 10.41); P=0.035) was associated with major bleeding, together with previous hemorrhagic stroke (OR: 6.678; 95%CI (1.356, 32.893); P=0.02), previous peptic ulcer (OR: 4.512; 95%CI (1.582, 12.864); P=0.005), previous MI (OR: 3.179; 95%CI (1.147, 8.809); P=0.026) and low serum albumin (OR: 2.357; 95%CI (1.030, 5.394); P=0.042). Conclusions: PRECISE-DAPT score was an efficient system to predict major bleeding in patients 75 years. However, higher cut-off score of 33 might be a more rational approach for predicting major bleeding risk in these patients. In addition, history of hemorrhagic stroke, peptic ulcer, myocardial infarction, as well as malnutrition, were strong predictors for major bleeding events in patients 75years.