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

Published on Mar 1, 2019in Revista Espanola De Cardiologia 5.13
· DOI :10.1016/j.rec.2018.06.004
Sergio Raposeiras-Roubín13
Estimated H-index: 13
Berenice Caneiro Queija2
Estimated H-index: 2
+ 35 AuthorsEmad Abu Assi16
Estimated H-index: 16
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 (PARIS ischemic and PARIS hemorrhagic ). 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). PARIS ischemic and PARIS hemorrhagic 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.
  • References (28)
  • Citations (1)
Published on Aug 1, 2017in Heart 5.08
Joakim Alfredsson16
Estimated H-index: 16
(Linköping University),
Benjamin Neely7
Estimated H-index: 7
(Duke University)
+ 12 AuthorsKeith A.A. Fox113
Estimated H-index: 113
(Edin.: University of Edinburgh)
Objectives Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there are no decision support tools available to predict an individual patient’s bleeding risk during DAPT treatment in the post-ACS setting. Methods To develop a longitudinal bleeding risk prediction model, we analy sed 9240 patients with unstable a...
Published on Apr 1, 2017in American Heart Journal 4.02
Gregory Ducrocq22
Estimated H-index: 22
(French Institute of Health and Medical Research),
Phillip J. Schulte20
Estimated H-index: 20
(Duke University)
+ 13 AuthorsRichard C. Becker83
Estimated H-index: 83
(University of Cincinnati Academic Health Center)
Background Evaluation of antithrombotic treatments for acute coronary syndromes (ACS) requires balancing ischemic and bleeding risks to assess net benefit. We sought to compare the relative effects of ischemic and bleeding events on mortality. Methods In the PLATelet inhibition and patient Outcomes (PLATO) trial, we compared spontaneous ischemic events (myocardial infarction or stroke) with spontaneous major bleeding events (PLATO major, Thrombolysis In Myocardial Infarction [TIMI] major, Global...
Published on Mar 1, 2017in The Lancet 59.10
Francesco Costa20
Estimated H-index: 20
(UNIME: University of Messina),
David van Klaveren15
Estimated H-index: 15
(Tufts Medical Center)
+ 16 AuthorsAntonio Colombo126
Estimated H-index: 126
Summary 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-patie...
Published on Nov 13, 2016in European Heart Journal 23.24
Marco Valgimigli78
Estimated H-index: 78
(University of Bern),
Francesco Costa20
Estimated H-index: 20
(UNIME: University of Messina)
+ 11 AuthorsPhilip E. Aylward47
Estimated H-index: 47
(Flinders University)
textabstractAims Dual antiplatelet therapy reduces non-fatal ischaemic events after acute coronary syndrome (ACS) but increases bleeding to a similar extent. We sought to determine the prognostic impact of myocardial infarction (MI) vs. bleeding during an extended follow-up period to gain insight into the trade-off between efficacy and safety among patients after ACS. Methods and results In 12 944 patients with non-ST-segment elevation ACS from the Thrombin Receptor Antagonist for Clinical Event...
Published on Sep 1, 2016in Journal of the American College of Cardiology 18.64
Glenn N. Levine38
Estimated H-index: 38
Eric R. Bates77
Estimated H-index: 77
(UM: University of Michigan)
+ 14 AuthorsLaura Mauri67
Estimated H-index: 67
Jonathan L. Halperin, MD, FACC, FAHA, Chair Glenn N. Levine, MD, FACC, FAHA, Chair-Elect Sana M. Al-Khatib, MD, MHS, FACC, FAHA Kim K. Birtcher, PharmD, MS, AACC Biykem Bozkurt, MD, PhD, FACC, FAHA Ralph G. Brindis, MD, MPH, MACC, FAHA Joaquin E. Cigarroa, MD, FACC Lesley H. Curtis, PhD,
Published on Jul 1, 2016in Jacc-cardiovascular Interventions 9.54
Usman Baber31
Estimated H-index: 31
(ISMMS: Icahn School of Medicine at Mount Sinai),
George Dangas85
Estimated H-index: 85
(ISMMS: Icahn School of Medicine at Mount Sinai)
+ 16 AuthorsTimothy D. Henry61
Estimated H-index: 61
(Cedars-Sinai Medical Center)
Abstract Objectives The aim of this study was to examine the independent associations between actionable bleeding (AB) and coronary thrombotic events (CTE) on mortality risk after percutaneous coronary intervention (PCI). Background The independent impact of AB and CTE on mortality risk after PCI remains poorly characterized. Methods A post hoc analysis was conducted of the PARIS (Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients) registry, a real-world cohort of 5,018 p...
Published on May 1, 2016in Journal of the American College of Cardiology 18.64
Usman Baber31
Estimated H-index: 31
(ISMMS: Icahn School of Medicine at Mount Sinai),
Roxana Mehran117
Estimated H-index: 117
(ISMMS: Icahn School of Medicine at Mount Sinai)
+ 18 AuthorsC. Michael Gibson89
Estimated H-index: 89
(Harvard University)
Abstract Background Dual-antiplatelet therapy with aspirin and clopidogrel after percutaneous coronary intervention reduces the risk for coronary thrombotic events (CTEs) at the expense of increasing risk for major bleeding (MB). Metrics to accurately predict the occurrence of each respective event and inform clinical decision making are lacking. Objectives The aim of this study was to develop and validate separate models to predict risks for out-of-hospital thrombotic and bleeding events after ...
Cited By1
Published on Feb 1, 2019in BMJ Open 2.38
Nafiu Ismail (Keele University), Kelvin P. Jordan41
Estimated H-index: 41
(Keele University)
+ 4 AuthorsMamas A. Mamas37
Estimated H-index: 37
(Keele University)
Objective The primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting. Design A narrative systematic review. Data source Medline, Embase, Amed and Central (Cochrane) were searched up to August 2018. Study selection...