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Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access
Published on: November 19, 2020
Validation of the DAPT score in real-world patients undergoing coronary stent implantation
Guy Witberg1, Oren Zusman1, Tamir Bental1
1The Department of Cardiology, Rabin Medical Center, Petah-Tikva, Israel; The Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Insights
The Dual Antiplatelet Therapy (DAPT) score may not accurately predict outcomes for patients undergoing PCI. Extending DAPT beyond 12 months showed no significant benefit in reducing myocardial infarction or bleeding events when stratified by DAPT score.
Area of Science:
- Cardiology
- Clinical Decision Making
- Health Services Research
Background:
- Dual Antiplatelet Therapy (DAPT) is crucial after percutaneous coronary intervention (PCI).
- The DAPT score is a tool to guide DAPT duration, but its real-world applicability needs validation.
- Assessing the DAPT score's external validity is essential for optimizing patient care.
Purpose of the Study:
- To evaluate the external validity of the DAPT score decision tool in a real-world patient population.
- To compare clinical outcomes (myocardial infarction and bleeding) based on DAPT duration (12 vs. 12+ months) stratified by DAPT score.
- To determine if the DAPT score accurately predicts the benefit of extended DAPT therapy.
Main Methods:
- Retrospective analysis of an all-comers PCI registry.
- Inclusion of 12,162 patients, with a focus on those completing 1 year of DAPT.
- Comparison of myocardial infarction (MI) and actionable bleeding rates between 12-month and 12+ month DAPT groups, stratified by DAPT score categories (high and low).
Main Results:
- Overall, 12+ months of DAPT was associated with reduced MI rates (2.8% vs. 4.0%, p=0.025) but similar bleeding rates (2.6% vs. 1.9%, p=0.281) compared to 12 months.
- When stratified by DAPT score, no significant differences in MI or bleeding rates were observed between 12-month and 12+ month DAPT durations for both high and low DAPT score groups.
- Combined clinical events (MI + bleeding) were similar between the DAPT duration groups across both high and low DAPT score strata.
Conclusions:
- The DAPT score's external validity is limited in real-world patients completing one year of DAPT post-PCI.
- Extending DAPT beyond 12 months did not demonstrate differential benefits in reducing MI or actionable bleeding when stratified by DAPT score.
- Further research with larger cohorts is necessary to fully validate the DAPT score's utility in clinical decision-making for DAPT duration.
Objectives:
To assess the external validity of the Dual Antiplatelet Therapy (DAPT) score decision tool in real world patients.
Methods And Results:
Retrospective study using an all comers PCI registry. We compared the rates of myocardial infarction (MI) and actionable bleeding between 12 vs. 12+ months DAPT stratified by DAPT score category. Of 12,162 patients, 4471 (36.8%) completed a year of DAPT without events. The high DAPT score stratum patients were older and had a higher comorbidity burden. Overall, 12+ months DAPT duration was associated with reduced rates of MI (2.8% vs. 4.0%, p = 0.025) and similar rates of bleeding (2.6% vs. 1.9%, p = 0.281) compared to 12 months DAPT, but when stratified by DAPT score stratum, there was no difference in any of the outcomes in both high score group, (3.7% vs. 5.3%, p = 0.111 and 2.0% vs. 1.8%, p = 0.800, for MI and bleeding, respectively) and low score patients (2.7% vs. 3.1%, p = 0.656 and 2.8% vs. 2.0%, p = 0.308, for MI and bleeding, respectively). Overall clinical events (MI + bleeding) was again similar between patients treated with 12+ vs. 12 months DAPT (5.5% vs. 6.2%, p = 0.535 and 5.1% vs. 4.4%, p = 0.503 for high and low DAPT score, respectively).
Conclusions:
for real world patients completing 1 year of DAPT post PCI, rates of MI, actionable bleeding, and their combination did not differ between those treated with 12+ vs. 12 months DAPT stratified by DAPT score stratum. Clinicians should be aware of the DAPT score's limitations. Further studies examining the validity of the DAPT score in larger cohorts are required.
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