AIMS To summarise the totality of evidence validating the Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE-DAPT) score, ascertaining its aggregate discrimination and validation power in multiple population subsets. METHODS AND RESULTS We searched electronic databases from 2017 (PRECISE-DAPT proposal) up to March 2023 for studies that reported the occurrence of out-of-hospital bleedings according to the PRECISE-DAPT score in patients receiving DAPT following percutaneous coronary intervention (PCI). Pooled odds ratio (OR) with 95% confidence interval (CI) were used as summary statistics and were calculated using a random-effects model. Primary and secondary endpoints were the occurrence of any and major bleeding, respectively. A total of twenty-one studies and 67 283 patients were included; 24.7% of patients (N = 16 603) were at high-bleeding risk (PRECISE-DAPT ≥ 25) and when compared to those at low-bleeding risk, they experienced a significantly higher rate of any out-of-hospital bleeding (OR: 2.71; 95% CI: 2.24-3.29; p-value < 0.001) and major bleedings (OR: 3.51; 95% CI: 2.71-4.55; p-value < 0.001). Pooling data on c-stat whenever available, the PRECISE-DAPT score showed a moderate discriminative power in predicting major bleeding events at 1-year (pooled c-stat: 0.71; 95% CI: 0.64-0.77). CONCLUSION This systematic review and meta-analysis confirms the external validity of the PRECISE-DAPT score in predicting out-of-hospital bleeding outcomes in patients on DAPT following PCI. The moderate discriminative ability highlights the need for future improved risk prediction tools in the field.

中文翻译：

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接受 PCI 患者的 PRECISE-DAPT 评分的外部有效性：系统评价和荟萃分析。

目的 总结验证接受支架植入和随后双重抗血小板治疗的患者的预测出血并发症 (PRECISE-DAPT) 评分的全部证据，确定其在多个人群子集中的总体区分度和验证能力。方法和结果 我们检索了 2017 年（PRECISE-DAPT 提案）至 2023 年 3 月的电子数据库，查找根据 PRECISE-DAPT 评分报告经皮冠状动脉介入治疗 (PCI) 后接受 DAPT 患者院外出血发生情况的研究。使用具有 95% 置信区间 (CI) 的合并比值比 (OR) 作为汇总统计数据，并使用随机效应模型进行计算。主要和次要终点分别是任何出血和大出血的发生。总共纳入 21 项研究和 67 283 名患者；24.7% 的患者 (N = 16 603) 处于高出血风险 (PRECISE-DAPT ≥ 25)，与低出血风险的患者相比，他们的院外出血率显着更高 (OR ：2.71；95% CI：2.24-3.29；p 值 < 0.001）和大出血（OR：3.51；95% CI：2.71-4.55；p 值 < 0.001）。汇集可用的 c-stat 数据后，PRECISE-DAPT 评分在预测 1 年大出血事件方面显示出中等判别力（汇集 c-stat：0.71；95% CI：0.64-0.77）。结论 这项系统评价和荟萃分析证实了 PRECISE-DAPT 评分在预测 PCI 后接受 DAPT 的患者院外出血结果方面的外部有效性。中等的判别能力凸显了未来对该领域改进风险预测工具的需求。