{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:23:28Z","timestamp":1781076208901,"version":"3.54.1"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Longitudinal bleeding risk scores have been validated in patients treated with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention. How these scores apply to the population of patients with acute coronary syndrome (ACS) treated without revascularization remains unknown. The objective was to evaluate and compare the performances of the PRECISE-DAPT, PARIS, and DAPT (bleeding component) bleeding risk scores in the medically managed patients with ACS treated with DAPT.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>TRILOGY ACS (Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes) was a double-blind, placebo-controlled randomized trial conducted from 2008 to 2012 over a median follow-up of 17.0 months in 966 sites (52 countries). High-risk patients with unstable angina or non\u2013ST-segment\u2013elevation myocardial infarction who did not undergo revascularization were randomized to prasugrel or clopidogrel. The PRECISE-DAPT, PARIS, and DAPT (bleeding component) risk scores were applied in the TRILOGY ACS population to evaluate their performance to predict adjudicated non\u2013coronary artery bypass grafting\u2013related GUSTO (Global Use of Strategies to Open Occluded Coronary Arteries) severe\/life-threatening\/moderate and TIMI (Thrombolysis in Myocardial Infarction) major\/minor bleeding with time-dependent c-indices. Among the 9326 participants, median age was 66 years (interquartile range, 59\u201374 years), and 3650 were females (39.1%). A total of 158 (1.69%) GUSTO severe\/life-threatening\/moderate and 174 (1.87%) TIMI major\/minor non\u2013coronary artery bypass grafting bleeding events occurred. The c-indices (95% CI) of the PRECISE-DAPT, PARIS, and DAPT (bleeding component) scores through 12 months were 0.716 (0.677\u20130.758), 0.693 (0.658\u20130.733), and 0.674 (0.637\u20130.713), respectively, for GUSTO bleeding and 0.624 (0.582\u20130.666), 0.612 (0.578\u20130.651), and 0.608 (0.571\u20130.649), respectively, for TIMI bleeding. There was no significant difference in the c-indices of each score based upon pairwise comparisons.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among medically managed patients with ACS treated with DAPT, the performances of the PRECISE-DAPT, PARIS, and DAPT (bleeding component) scores were reasonable and similar to their performances in the derivation percutaneous coronary intervention populations. Bleeding risk scores may be used to predict longitudinal bleeding risk in patients with ACS treated with DAPT without revascularization and help support shared decision making.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Registration:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT00699998.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.120.006582","type":"journal-article","created":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T09:00:31Z","timestamp":1598864431000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Long-Term Bleeding Risk Prediction with Dual Antiplatelet Therapy After Acute Coronary Syndromes Treated Without Revascularization"],"prefix":"10.1161","volume":"13","clinical-trial-number":[{"clinical-trial-number":"nct00699998","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2965-1504","authenticated-orcid":true,"given":"Guillaume","family":"Marquis-Gravel","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (G.M.G., M.L.N., R.A., E.M.O., M.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L.","family":"Neely","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (G.M.G., M.L.N., R.A., E.M.O., M.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Valgimigli","sequence":"additional","affiliation":[{"name":"Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (M.V., F.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Costa","sequence":"additional","affiliation":[{"name":"Swiss Cardiovascular Center Bern, Bern University Hospital, Switzerland (M.V., F.C.)."},{"name":"Department of Clinical and Experimental Medicine, Policlinic \u201cG. Martino\u201d, University of Messina, Italy (F.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Van Klaveren","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Center, the Netherlands (D.V.K.)."},{"name":"Predictive Analytics and Comparative Effectiveness Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (D.V.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rituparna","family":"Altner","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (G.M.G., M.L.N., R.A., E.M.O., M.T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1278-6245","authenticated-orcid":true,"given":"Deepak L.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre and Division of Cardiology, University of Alberta, Edmonton, Canada (P.W.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0140-2752","authenticated-orcid":true,"given":"Keith A. 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