High bleeding risk and outcomes in left main percutaneous coronary intervention: prognostic value of the PRECISE-DAPT score

The PRECISE-DAPT score is a standardized tool for assessing bleeding risk. However, its prognostic value in patients undergoing left main (LM) percutaneous coronary intervention (PCI) remains unclear. This study evaluated the association between high bleeding risk (HBR), defined by the PRECISE-DAPT score, and clinical outcomes following LM PCI. This retrospective study analyzed consecutive patients undergoing LM PCI at a tertiary medical center. Patients were stratified into HBR (score ≥ 25) and non-HBR (score < 25) groups. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), a composite of all-cause death, myocardial infarction, or stroke at one year. Among 489 patients, 251 (51.3%) were classified as HBR. Compared with the non-HBR group, HBR patients exhibited significantly greater frailty, a higher burden of comorbidities, and more complex lesion characteristics. In multivariate Cox regression analysis, HBR was independently associated with an increased risk of MACCE (adjusted HR: 4.22; 95% CI: 2.03 to 8.77; P < 0.001) and bleeding events (adjusted HR: 5.11; 95% CI: 1.46 to 17.90; P = 0.01). Harrell’s C-index demonstrated good discrimination for MACCE (0.75; 95% CI: 0.70 to 0.79) and moderate discrimination for bleeding events (0.68; 95% CI: 0.57 to 0.79). HBR, as determined by the PRECISE-DAPT score, is prevalent among patients undergoing LM PCI and associates with increased frailty, comorbidity burden, and adverse ischemic and bleeding outcomes. The PRECISE-DAPT score effectively stratifies systemic risk and supports its integration into clinical decision-making for this high-risk population.