부산대학교 도서관

Background:The PRECISE-DAPT (P-DAPT) score has been validated in large cohorts as an effective tool in predicting bleeding complication after dual antiplatelets therapy as well as in predicting in-hospital mortality. The implication of using this score to predict outcomes including mortality in patients with atrial fibrillation (AF) is unknown.Methods:The population includes 22,093 consecutive patients who underwent percutaneous coronary intervention (PCI) across a large multihospital healthcare system since 2010. Patients were stratified into 4 groups depending on the presence or absence of atrial fibrillation and P-DAPT score, with ?25 being defined as high risk for bleeding complications. Outcomes including mortality, readmission, and major bleeding were evaluated.Results:Of the 22,093 patients undergoing PCI, 12,911 had no AF and P-DAPT< 25 (Group 0), 1394 had AF and P-DAPT?25 (Group 1), 1014 had AF and P-DAPT<25 (Group 2), and 6774 had no AF and P-DAPT?25 (Group 3). In the unadjusted analyses, a P-DAPT score ?25, in both AF and non-AF population, was associated with increased mortality (Figure), readmission, and bleeding. After adjusting for baseline characteristics, in comparison with the group with P-DAPT<25 and no AF, there were no significant differences in major bleeding across groups. However, among those without AF, high P-DAPT score was associated with a higher risk for readmission (HR 1.07; 95% CI 1.05-1.1) and mortality (HR 1.50; 95% CI 1.43-1.57). Among those with AF, P-DAPT was strongly associated with readmission (HR 1.48; 95% CI 1.34-1.63) and mortality (HR 3.72; 95% CI 3.07-4.49).Conclusions:In a large cohort of patients undergoing PCI, P-DAPT score can identify those patients at high risk for long-term mortality, particularly among those with atrial fibrillation. Further work is required to evaluate the causes of adverse outcomes and possible interventions to mitigate them.