Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2019;72:215-23 - Vol. 72 Num.03 DOI: 10.1016/j.rec.2018.06.004

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

Sergio Raposeiras-Roubín a, Berenice Caneiro Queija a, Fabrizio D'Ascenzo b, Tim Kinnaird c, Albert Ariza-Solé d, Sergio Manzano-Fernández e, Christian Templin f, Lazar Velicki g,h, Ioanna Xanthopoulou i, Enrico Cerrato j, Giorgio Quadri k, Andrea Rognoni l, Giacome Boccuzzi m, Andrea Montabone m, Salma Taha n, Alessandro Durante o, Sebastiano Gili f, Giulia Magnani f, Michele Autelli b, Alberto Grosso b, Pedro Flores Blanco e, Alberto Garay d, Ferdinando Varbella k, Francesco Tomassini k, Rafael Cobas Paz a, María Cespón Fernández a, Isabel Muñoz Pousa a, Diego Gallo p, Umberto Morbiducci p, Alberto Domínguez-Rodríguez q, José Antonio Baz-Alonso a, Francisco Calvo-Iglesias a, Mariano Valdés e, Ángel Cequier d, Fiorenzo Gaita b, Dimitrios Alexopoulos i, Andrés Íñiguez-Romo a, Emad Abu-Assi a,

a Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
b Department of Cardiology, Department of Medical Sciences, University of Torino, Torino, Italy
c Cardiology Department, University Hospital of Wales, Cardiff, United Kingdom
d Servicio de Cardiología, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
f Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
g Medical Faculty, University of Novi Sad, Novi Sad, Serbia
h Institute of Cardiovascular Diseases Vojvodina, Sremska Kamenica, Serbia
i Department of Cardiology, Patras University Hospital, Rion, Patras, Greece
j Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Torino, Italy
k Department of Cardiology, Infermi Hospital, Rivoli, Italy
l Coronary Care Unit and Catheterization Laboratory, A.O.U. Maggiore della Carità, Novara, Italy
m Department of Cardiology, S.G. Bosco Hospital, Torino, Italy
n Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
o Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy
p PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Italy
q Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

Refers to

Limitations of Current Risk Scoring in Real World Populations: The Importance of External Validation
Sabato Sorrentino, Usman Baber, Roxana Mehran
Rev Esp Cardiol. 2019;72:192-4
Full text - PDF

Keywords

Bleeding. Reinfarction. Ticagrelor. Prasugrel. PARIS score. Acute coronary syndrome.

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.

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1885-5857/© 2019 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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