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Performance of DAPT Score and ESC Criteria for Predicting Clinical Outcomes in Chinese Patients with Acute Coronary
Tianhua Deng1, Lin Huang1, Zhengli Ran1
1Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People's Republic of China.
Insights
European Society of Cardiology (ESC) criteria effectively identified high-risk patients for major adverse cardiovascular events (MACE) after acute coronary syndrome (ACS). The ESC criteria showed better predictive ability for MACE than the dual antiplatelet therapy (DAPT) score.
Area of Science:
- Cardiology
- Clinical Risk Stratification
- Cardiovascular Research
Background:
- Acute coronary syndrome (ACS) management involves dual antiplatelet therapy (DAPT).
- Accurate ischemic risk stratification is crucial for optimizing DAPT duration and intensity.
- Existing risk scores, such as the European Society of Cardiology (ESC) criteria and the DAPT score, aim to guide treatment decisions.
Purpose of the Study:
- To evaluate the effectiveness of European Society of Cardiology (ESC) criteria in stratifying ischemic risk.
- To compare the predictive performance of ESC criteria versus the dual antiplatelet therapy (DAPT) score for major adverse cardiovascular events (MACE) in ACS patients on DAPT.
Main Methods:
- A cohort of 489 ACS patients receiving DAPT at discharge was analyzed.
- The primary endpoint was the occurrence of MACE (recurrent ACS, unplanned revascularization, all-cause death, or ischemic stroke) over a 27-month follow-up.
- Statistical analysis included hazard ratios, C-indices, and DeLong tests to compare predictive values.
Main Results:
- Patients classified as high-risk by ESC criteria had significantly higher rates of MACE, all-cause death, and recurrent ACS/unplanned revascularization.
- The ESC criteria demonstrated a better discriminatory ability for MACE prediction (C-index 0.63) compared to the DAPT score (C-index 0.54).
- No significant difference in MACE incidence was observed between patients with DAPT scores ≥2 and <2.
Conclusions:
- ESC-defined high-risk patients face a substantially elevated risk of MACE following ACS.
- The ESC criteria exhibit superior predictive performance for MACE compared to the DAPT score in this patient population.
- ESC criteria offer moderate discriminatory capacity for MACE in ACS patients treated with DAPT.
Purpose:
The values of European Society of Cardiology (ESC) criteria and dual antiplatelet therapy (DAPT) score in the stratification of ischemic risk were assessed in this study.
Methods:
A total of 489 patients with acute coronary syndrome who received DAPT at discharge between June 2020 and August 2020 were enrolled. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), which included recurrent ACS or unplanned revascularization, all-cause death, or ischemic stroke during a 27-month follow-up period.
Results:
Patients with ESC-defined high-risk showed a significantly higher risk of MACE (HR 2.75, 95% CI 1.78-4.25), all-cause death (HR 2.49, 95% CI 1.14-5.43), and recurrent ACS or unplanned revascularization (HR 2.80, 95% CI 1.57-4.99) than those with ESC-defined low/medium-risk during follow-up. The results of landmark analysis showed that patients in the high-risk group had a significantly higher risk of MACE (HR 2.80,95 CI% 1.57-4.97), recurrent ACS or unplanned revascularization (HR 3.19,95 CI% 1.47-6.93) within one year, and a higher risk of MACE (HR 2.69,95 CI% 1.38-5.23) after one year. There was no significant difference in the incidence of MACE between patients with a DAPT score ≥2 and a DAPT score <2. The C-indices of ESC criteria and DAPT score for prediction of MACE were 0.63 (95% CI 0.57-0.70) and 0.54 (95% CI 0.48-0.61), respectively. The predictive value of ESC criteria for MACE was better than the DAPT score according to the DeLong test (z-statistic=2.30, P=0.020).
Conclusion:
Patients with ESC-defined high-risk had a higher risk of MACE compared to those with ESC-defined low/medium-risk. The discriminant ability of the ESC criteria was better than the DAPT score for MACE. The ESC criteria demonstrated moderate discriminatory capacity of MACE in ACS patients treated with DAPT.
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