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Rev Esp Cardiol (Engl Ed). 2019 Mar;72(3):215-223. doi: 10.1016/j.rec.2018.06.004. Epub 2018 Jul 18.

Usefulness of the PARIS Score to Evaluate the Ischemic-hemorrhagic Net Benefit With Ticagrelor and Prasugrel After an Acute Coronary Syndrome.

[Article in English, Spanish]

Author information

1
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
2
Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy.
3
Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom.
4
Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
5
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain.
6
Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
7
Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia.
8
Department of Cardiology, Patras University Hospital, Rion, Patras, Greece.
9
Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy.
10
Department of Cardiology, Infermi Hospital, Rivoli, Italy.
11
Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy.
12
Department of Cardiology, S.G. Bosco Hospital, Torino, Italy.
13
Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt.
14
Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy.
15
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy.
16
Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
17
Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain. Electronic address: eabuassi@gmail.com.

Abstract

INTRODUCTION AND OBJECTIVES:

The PARIS score allows combined stratification of ischemic and hemorrhagic risk in patients with ischemic heart disease treated with coronary stenting and dual antiplatelet therapy (DAPT). Its usefulness in patients with acute coronary syndrome (ACS) treated with ticagrelor or prasugrel is unknown. We investigated this issue in an international registry.

METHODS:

Retrospective multicenter study with voluntary participation of 11 centers in 6 European countries. We studied 4310 patients with ACS discharged with DAPT with ticagrelor or prasugrel. Ischemic events were defined as stent thrombosis or spontaneous myocardial infarction, and hemorrhagic events as BARC (Bleeding Academic Research Consortium) type 3 or 5 bleeding. Discrimination and calibration were calculated for both PARIS scores (PARISischemic and PARIShemorrhagic). The ischemic-hemorrhagic net benefit was obtained by the difference between the predicted probabilities of ischemic and bleeding events.

RESULTS:

During a period of 17.2 ± 8.3 months, there were 80 ischemic events (1.9% per year) and 66 bleeding events (1.6% per year). PARISischemic and PARIShemorrhagic scores were associated with a risk of ischemic events (sHR, 1.27; 95%CI, 1.16-1.39) and bleeding events (sHR, 1.14; 95%CI, 1.01-1.30), respectively. The discrimination for ischemic events was modest (C index = 0.64) and was suboptimal for hemorrhagic events (C index = 0.56), whereas calibration was acceptable for both. The ischemic-hemorrhagic net benefit was negative (more hemorrhagic events) in patients at high hemorrhagic risk, and was positive (more ischemic events) in patients at high ischemic risk.

CONCLUSIONS:

In patients with ACS treated with DAPT with ticagrelor or prasugrel, the PARIS model helps to properly evaluate the ischemic-hemorrhagic risk.

KEYWORDS:

Acute coronary syndrome; Bleeding; Hemorragia; PARIS score; Prasugrel; Puntuación PARIS; Reinfarction; Reinfarto; Síndrome coronario agudo; Ticagrelor

PMID:
30029980
DOI:
10.1016/j.rec.2018.06.004
[Indexed for MEDLINE]

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