Risk Scores Predict Death, Stroke Well, But Not MI or Bleeding

Risk assessment scores were effective at predicting cardiovascular and ischemic endpoints such as mortality, a new analysis in Atherosclerosis suggests.

“Thromboischemic and bleeding events are rare but life-threatening complications after percutaneous coronary intervention (PCI),” the authors wrote. “Various risk assessment models have been established to predict short- and long-term adverse events in patients with chronic and acute coronary syndromes.”

The researchers, looking to compare available risk assessment systems on their ability to identify high-risk patients with symptomatic coronary artery disease (CAD) included more than 1,500 consecutive patients (n=1,565) with symptomatic CAD (821 patients with chronic disease and 744 with acute) and were followed-up for endpoints at one, three and five years. Endpoints included all-cause death, myocardial infarction (MI), ischemic stroke (IS), and bleeding. The authors calculated the CALIVER, DAPT, GRACE 2.0, PARIS-CTE, PARIS-MB, PRECISE DAPT, and PREDICT-STABLE scores for all groups. The primary study endpoint was a combined ischemic endpoint of all-cause death, MI, and/or ischemic stroke, with secondary endpoints defined as single occurrence of either all-cause death, MI, ischemic stroke, or bleeding.

According to the study results, the GRACE 2.0 score demonstrated good discrimination performance for predicting the combined ischemic endpoint at three and five year follow-up. Additionally, CALIBER, GRACE 2.0, and PARIS-CTE all performed best at predicting all-cause death throughout follow-up. PARIS-CTE and CALIBER best predicted ischemic stroke. None of the scores, however, did well at predicting MI or bleeding.

“CALIBER, GRACE 2.0, PARIS-MB and PRECISE-DAPT scores showed good performance in predicting all-cause death at one, three, and five years follow-up,” the authors wrote. “Combined ischemic endpoint (all-cause death, myocardial infarction and/or ischemic stroke) was best predicted by GRACE 2.0 score. None of the investigated scores could efficiently predict MI or bleeding complications in short- and long-term follow-up.”

Predicting 1-, 3- and 5-year outcomes in patients with coronary artery… https://t.co/bbDjs9d2St pic.twitter.com/2YRf2vnk8K

— Miguel A. Maria. Medico de Familia (@Miguel_A_Maria) December 15, 2020