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A systematic review of the studies that evaluate the performance of the DAPT score
Chun Shing Kwok1,2, Chun Wai Wong1,2, Vinayak Nagaraja1,2
1Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.
Insights
The Dual Antiplatelet Therapy (DAPT) score shows modest ability to predict ischemic and bleeding events after 12 months. Further randomized trials are needed to confirm its clinical utility in guiding prolonged DAPT therapy.
Area of Science:
- Cardiology
- Clinical Pharmacology
- Evidence Synthesis
Background:
- The Dual Antiplatelet Therapy (DAPT) score aids in deciding prolonged DAPT beyond 12 months post-PCI, balancing ischemic and bleeding risks.
- Previous validation studies of the DAPT score have yielded inconsistent results.
Purpose of the Study:
- To systematically review and synthesize findings from studies evaluating the DAPT score in Percutaneous Coronary Intervention (PCI) populations.
- To assess the predictive performance of the DAPT score for ischemic and bleeding events.
Main Methods:
- Systematic review of studies on DAPT score in PCI populations.
- Searches conducted on MEDLINE and EMBASE databases.
- Data extraction and narrative synthesis by two independent reviewers.
Main Results:
- Included 13 studies with diverse designs (RCTs, cohorts, case-control).
- DAPT score demonstrated modest predictive value (C-statistics for ischemic outcomes: 0.53-0.71; bleeding outcomes: 0.49-0.71).
- One RCT indicated DAPT continuation reduced MI deaths but increased bleeding.
Conclusions:
- The DAPT score has a modest predictive value for ischemic and bleeding outcomes, though not originally designed for this purpose.
- High-quality prospective randomized controlled trials are necessary to determine the clinical benefit of using the DAPT score to guide extended DAPT therapy.
Background:
The Dual Antiplatelet Therapy (DAPT) score was derived to determine which patients may benefit from prolonged DAPT therapy after 12 months based on the balance between ischaemic and bleeding events. Several studies have attempted to validate the score with inconsistent findings.
Methods:
We conducted a systematic review of the studies that evaluated the DAPT score in PCI populations. A search was performed on MEDLINE and EMBASE and two independent reviewers reviewed the search results for study inclusion and extracted data from studies which met the inclusion criteria. Data are presented in tables and narrative synthesis was performed.
Results:
A total of 13 studies were included in this review. The study designs included post hoc analysis of randomised trials, prospective cohorts, retrospective cohorts and a case-control study. In the derivation/validation study, the c-statistic for ischaemic and bleeding outcomes were 0.64/0.70 and 0.68/0.64, respectively. Among the validation studies, the C-statistics for composite outcomes ranged from 0.53 to 0.71 for ischaemic outcomes and 0.49 to 0.71 for bleeding outcomes. Only one study randomised patients with high DAPT score to different combinations of antiplatelet after 1 year of DAPT and found that continuation of DAPT was associated with fewer deaths because of myocardial infarction, but more bleeding.
Conclusions:
While not designed for this purpose many studies have shown that the DAPT score has modest predictive value for ischaemic and bleeding outcomes. A prospective randomised controlled trial is needed to evaluate the clinical benefits of utilising the DAPT score in guiding continued DAPT therapy beyond 1 year.
