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Lookup NU author(s): Professor Vijay KunadianORCiD
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© 2026 American College of Cardiology Foundation.Background Among high–bleeding risk (HBR) patients undergoing coronary stenting, abbreviated dual antiplatelet therapy (DAPT) reduces bleeding without ischemic risk trade-off; whether these benefits persist across the entire spectrum of bleeding risk has not been investigated. Objectives The aim of this study is to explore the value of the novel PRECISE-HBR score as a risk stratification tool to guide DAPT duration in patients at high bleeding risk. Methods The XIENCE Short DAPT program combined 3 international single-arm studies of HBR patients treated with cobalt-chromium everolimus-eluting stents who discontinued DAPT at 1 month (XIENCE 28 USA/Global) or 3 months (XIENCE 90), if event free and treatment adherent. Bleeding risk was classified as nonhigh (PRECISE-HBR score ≤22), high (score 23-26), or very high (score ≥27). Clinical outcomes were assessed between 1 and 12 months using propensity score stratification. Results Among 3,364 patients, the PRECISE-HBR score was ≤22, 23-26, and ≥27 in 359 (10.7%), 744 (22.1%), and 2,261 (67.2%), respectively. Rates of BARC (Bleeding Academic Research Consortium) type 3-5 bleeding (0.3%, 2.5%, 5.6%) and death or myocardial infarction (2.9%, 4.6%, 9.8%) increased progressively across risk categories. One- versus 3-month DAPT was associated with a significant reduction in BARC type 3-5 bleeding in patients with a score ≥27 (HR: 0.59, 95% CI: 0.39-0.88) but not in those <27 (HR: 2.31, 95% CI: 0.89-5.99; P -interaction = 0.012). Ischemic risk was similar between 1- and 3-month DAPT, irrespective of the PRECISE-HBR score ( P -interaction = 0.40). Conclusions The PRECISE-HBR score identified patients at increased risk for both bleeding and ischemic events who seemed to derive greater benefit from 1-month DAPT after stent implantation.
Author(s): Cao D, Oliva A, Mehran R, Sartori S, Feng Y, Gragnano F, van Klaveren D, Angiolillo DJ, Bangalore S, Bhatt DL, Ge J, Hermiller J, Makkar RR, Neumann F-J, Saito S, Picon H, Toelg R, Maksoud A, Chehab BM, Choi JW, Campo G, de la Torre Hernandez JM, Krucoff MW, Kunadian V, Sardella G, Thiele H, Varenne O, Vranckx P, Windecker S, Valgimigli M
Publication type: Article
Publication status: Published
Journal: JACC: Cardiovascular Interventions
Year: 2026
Volume: 19
Issue: 13
Pages: 1766-1777
Online publication date: 13/07/2026
Acceptance date: 22/04/2026
ISSN (print): 1936-8798
ISSN (electronic): 1876-7605
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.jcin.2026.04.051
DOI: 10.1016/j.jcin.2026.04.051
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