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Sökning: WFRF:(Van Klaveren David) > (2017) > Derivation and vali...

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FältnamnIndikatorerMetadata
00005958naa a2200469 4500
001oai:DiVA.org:uu-318924
003SwePub
008170405s2017 | |||||||||||000 ||eng|
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3189242 URI
0247 a https://doi.org/10.1016/S0140-6736(17)30397-52 DOI
040 a (SwePub)uu
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Costa, Francescou Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.;Erasmus Univ, Med Ctr, Rotterdam, Netherlands.;Univ Messina, Policlin G Martino, Dept Clin & Expt Med, Messina, Italy.4 aut
2451 0a Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score :b a pooled analysis of individual-patient datasets from clinical trials
264 1c 2017
338 a print2 rdacarrier
520 a Background: Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y(12) inhibitor prevents ischaemic events after coronary stenting, but increases bleeding. Guidelines support weighting bleeding risk before the selection of treatment duration, but no standardised tool exists for this purpose.Methods: A total of 14 963 patients treated with DAPT after coronary stenting-largely consisting of aspirin and clopidogrel and without indication to oral anticoagulation-were pooled at a single-patient level from eight multicentre randomised clinical trials with independent adjudication of events. Using Cox proportional hazards regression, we identified predictors of out-of-hospital Thrombosis in Myocardial Infarction (TIMI) major or minor bleeding stratified by trial, and developed a numerical bleeding risk score. The predictive performance of the novel score was assessed in the derivation cohort and validated in patients treated with percutaneous coronary intervention from the PLATelet inhibition and patient Outcomes (PLATO) trial (n=8595) and BernPCI registry (n=6172). The novel score was assessed within patients randomised to different DAPT durations (n=10 081) to identify the effect on bleeding and ischaemia of a long (12-24 months) or short (3-6 months) treatment in relation to baseline bleeding risk.Findings: The PRECISE-DAPT score (age, creatinine clearance, haemoglobin, white-blood-cell count, and previous spontaneous bleeding) showed a c-index for out-of-hospital TIMI major or minor bleeding of 0.73 (95% CI 0.61-0.85) in the derivation cohort, and 0.70 (0.65-0.74) in the PLATO trial validation cohort and 0.66 (0.61-0.71) in the BernPCI registry validation cohort. A longer DAPT duration significantly increased bleeding in patients at high risk (score >= 25), but not in those with lower risk profiles (p(interaction)=0.007), and exerted a significant ischaemic benefit only in this latter group.Interpretation: The PRECISE-DAPT score is a simple five-item risk score, which provides a standardised tool for the prediction of out-of-hospital bleeding during DAPT. In the context of a comprehensive clinical evaluation process, this tool can support clinical decision making for treatment duration.
7001 a van Klaveren, Davidu Erasmus Univ, Med Ctr, Rotterdam, Netherlands.;Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA USA.4 aut
7001 a James, Stefan Ku Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)4 aut0 (Swepub:uu)stjam367
7001 a Heg, Diku Univ Bern, Inst Social & Prevent Med, Bern, Switzerland.4 aut
7001 a Raber, Lorenzu Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.4 aut
7001 a Feres, Faustou Ist Dante Pazzanese Cardiol, Sao Paulo, Brazil.4 aut
7001 a Pilgrim, Thomasu Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.4 aut
7001 a Hong, Myeong-Kiu Yonsei Univ, Coll Med, Severance Cardiovasc Hosp, Seoul, South Korea.;Yonsei Univ, Coll Med, Severance Biomed Sci Inst, Seoul, South Korea.4 aut
7001 a Kim, Hyo-Soou Seoul Natl Univ Hosp, Dept Internal Med, Seoul, South Korea.4 aut
7001 a Colombo, Antoniou EMO GVM Ctr Cuore Columbus, Milan, Italy.;Ist Sci San Raffaele, Intervent Cardiol Dept, Milan, Italy.4 aut
7001 a Steg, Philippe Gabrielu Hop Xavier Bichat, AP HP, Dept Cardiol, Paris, France.4 aut
7001 a Zanchin, Thomasu Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.4 aut
7001 a Palmerini, Tulliou Univ Bologna, Dipartimento Cardiotoracovasc, Bologna, Italy.4 aut
7001 a Wallentin, Larsu Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)4 aut0 (Swepub:uu)larswall
7001 a Bhatt, Deepak L.u Brigham & Womens Hosp, Heart & Vasc Ctr, 75 Francis St, Boston, MA 02115 USA.;Harvard Med Sch, Boston, MA USA.4 aut
7001 a Stone, Gregg W.u Columbia Univ, Med Ctr, New York Presbyterian Hosp, New York, NY USA.;Cardiovasc Res Fdn, New York, NY USA.4 aut
7001 a Windecker, Stephanu Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.4 aut
7001 a Steyerberg, Ewout W.u Erasmus Univ, Med Ctr, Rotterdam, Netherlands.4 aut
7001 a Valgimigli, Marcou Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.;Erasmus Univ, Med Ctr, Rotterdam, Netherlands.4 aut
7102 a Univ Hosp Bern, Swiss Cardiovasc Ctr Bern, CH-3010 Bern, Switzerland.;Erasmus Univ, Med Ctr, Rotterdam, Netherlands.;Univ Messina, Policlin G Martino, Dept Clin & Expt Med, Messina, Italy.b Erasmus Univ, Med Ctr, Rotterdam, Netherlands.;Tufts Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA USA.4 org
7730 t The Lancetg 389:10073, s. 1025-1034q 389:10073<1025-1034x 0140-6736x 1474-547X
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-318924
8564 8u https://doi.org/10.1016/S0140-6736(17)30397-5

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