Validation of contemporary risk scores in predicting coronary thrombotic events and major bleeding in patients with acute coronary syndrome after drug-eluting stent implantations

Objectives We aimed to assess the prognostic ability of the ST score, DAPT score, and PARIS score in a Chinese population. Background Recently, several risk scores predicting the long-term risk of coronary thrombotic events [CTE, defined as the composite of definite or probable stent thrombosis (ST) and myocardial infarction] and bleeding have been developed and initially validated in Western populations. Methods A total of 6,088 consecutive patients with acute coronary syndrome (mean age 58.3 ± 10.4; women 23.1%) treated with drug-eluting stents in 2013 at our single institution were enrolled. We calculated risk scores and evaluated their performance for predicting definite or probable ST, CTE and major bleeding (MB, defined as the occurrence of a Bleeding Academic Research Consortium type 3 or 5 bleed). The prognostic value of risk scores was assessed by receiver-operating characteristic curves. Results The ST score, DAPT score, and PARIS score all showed unsatisfactory discrimination to predict 2-year or 1- to 2-year ST and CTE (c-statistic = 0.51-0.59). With respect to bleeding outcomes, the PARIS score showed unsatisfactory discrimination in predicting 2-year MB (c-statistic = 0.56); the DAPT score performed slightly better than the PARIS score in predicting occurrence of later MB events between 1 and 2 years, whereas its discriminative capacity was only modest (c-statistic = 0.71). Conclusions The current three risk scores, derived and initially validated in Western populations, may not be applicable to the Chinese population, although DAPT score was determined to be a modestly accurate quantitative tool for prediction of later MB.