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Validation of the DAPT score in large-scale consecutive and contemporary patients population in the real world
Guofeng Gao1, Yanyan Zhao1, Dong Zhang1
1From State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Cardiovascular Institute, Fuwai Hospital and National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Insights
The Dual Antiplatelet Therapy (DAPT) score did not effectively predict ischemic or bleeding risks in patients undergoing percutaneous coronary intervention (PCI). This large study found similar event rates between low and high DAPT score groups.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Risk Stratification
Background:
- The Dual Antiplatelet Therapy (DAPT) score was developed to assess risks of ischemia and bleeding after percutaneous coronary intervention (PCI).
- Previous studies showed inconsistent predictive performance of the DAPT score.
- A need exists to validate the DAPT score in diverse patient populations and clinical settings.
Purpose of the Study:
- To evaluate the predictive utility of the DAPT score for ischemic and bleeding events in a large cohort of consecutive PCI patients.
- To assess whether the DAPT score can effectively stratify patients into low and high risk categories for adverse events.
- To determine if the DAPT score is an independent predictor of clinical outcomes post-PCI.
Main Methods:
- A large-scale cohort study including 9,114 patients who underwent PCI and adhered to DAPT.
- Patients were event-free for the first 12 months post-PCI.
- Outcomes assessed included major adverse cardiovascular and cerebrovascular events, myocardial infarction, stent thrombosis, and bleeding events between 12 and 24 months post-PCI.
- Patients were categorized into low (score <2) and high (score ≥2) DAPT score groups.
- Statistical analyses included multivariable analysis and receiver operating characteristic (ROC) curve analysis.
Main Results:
- The incidence of primary ischemic endpoints and bleeding endpoint was similar between the low and high DAPT score groups.
- Multivariable analysis revealed that the DAPT score was not an independent predictor of either ischemic or bleeding endpoints.
- Receiver operating characteristic (ROC) curve analysis showed that the C-statistic for the DAPT score was not significant for predicting ischemic or bleeding events.
Conclusions:
- In this large cohort of PCI patients, the DAPT score demonstrated a limited ability to discriminate between patients at high and low risk for ischemic and bleeding events.
- The findings suggest that the DAPT score may not be a reliable tool for risk stratification in this specific patient population.
- Further research may be needed to identify more accurate predictors of clinical outcomes after PCI and DAPT.
Abstract:
Dual antiplatelet therapy (DAPT) score emerged as a tool for quantification of ischemia and bleeding risks. However, there was discrepancy of the prediction ability of DAPT score in previous studies. We aimed to assess the utility of DAPT score in a large-scale cohort of consecutive percutaneous coronary intervention (PCI) patients. This study enrolled 9,114 patients who had undergone PCI at Fuwai Hospital in 2013, adhered to DAPT and were event-free within the first 12 months following PCI. The endpoints included primary ischemic endpoints (major adverse cardiovascular and cerebrovascular events, and myocardial infarction and/or stent thrombosis), and bleeding endpoint from 12 through 24 months after PCI. Patients were classified into low (score <2, n = 3,989) and high (score ≥2, n = 5,125) DAPT score groups. The incidence rates of primary ischemic endpoints and bleeding endpoint were similar between the two groups. Multivariable analysis demonstrated DAPT score not to be an independent predictor of primary ischemic endpoints or bleeding endpoint. Based on receiver operating characteristic curves analysis, the C-statistic of DAPT score for primary ischemic endpoints or bleeding endpoint did not achieve a significant extent. In this large-scale cohort of PCI patients, DAPT score did not discriminate the risks of ischemic and bleeding events.
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