Prognostic Role of the Precise DAPT Score on Long-Term Outcomes After Carotid Artery Stenting: A Retrospective Cohort
Altuğ Ösken1, Evliya Akdeniz2, Ahmet Öz3
1Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Health Sciences University, Istanbul, Türkiye.
Insights
The Precise DAPT score effectively predicts long-term mortality and stroke risk in patients undergoing carotid artery stenting (CAS). A high score (≥25) indicates significantly increased adverse events, aiding personalized treatment strategies for carotid interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Neurology
Background:
- Carotid artery stenosis is a primary cause of stroke, a leading global health concern.
- Carotid artery stenting (CAS) is a common procedure to mitigate stroke risk.
- The Precise DAPT score, initially for percutaneous coronary intervention (PCI), shows promise in predicting outcomes in other vascular procedures.
Purpose of the Study:
- To evaluate the prognostic value of the Precise DAPT score for short- and long-term outcomes in patients undergoing CAS.
- To determine if the Precise DAPT score can identify patients at higher risk of adverse events after CAS.
Main Methods:
- Retrospective cohort study of 376 patients undergoing CAS (December 2012 - January 2018).
- Analysis of the association between Precise DAPT score and clinical outcomes (mortality, stroke, complications).
- Statistical methods included Cox regression, survival analysis, and ROC curves.
Main Results:
- Patients with high Precise DAPT scores (≥25) showed significantly higher long-term mortality (36.3% vs. 6.1%) and major stroke events (18.6% vs. 9.1%).
- A high score was independently associated with increased long-term mortality (aHR 4.82) and major stroke (aHR 2.11).
- High-score group patients were older and had poorer renal function.
Conclusions:
- The Precise DAPT score serves as a valuable prognostic tool for patients undergoing CAS, extending its utility beyond PCI.
- The score is independently linked to long-term mortality and major stroke risk in CAS patients.
- Integrating the Precise DAPT score can improve risk stratification and personalize therapeutic strategies for carotid interventions.
Background:
Carotid artery stenosis is a major contributor to stroke, a leading cause of mortality and disability worldwide. Carotid artery stenting (CAS) is commonly performed to reduce the risk of stroke in affected individuals. The Precise DAPT score, originally designed to predict bleeding risk in percutaneous coronary intervention (PCI) patients, has shown potential in predicting adverse outcomes in other vascular interventions.
Aim:
This study investigates the role of the Precise DAPT score associated with short- and long-term clinical outcomes in patients undergoing CAS.
Methods:
A retrospective cohort study was conducted using data from 376 patients who underwent CAS at Health Sciences University Siyami Ersek Thoracic and Cardiovascular Surgery Center between December 2012 and January 2018. The study analyzed the relationship between the Precise DAPT score and short- and long-term outcomes, including peri-procedural complications, recurrent stroke, and mortality. Statistical analyses included Cox regression, survival analysis, and receiver operating characteristic (ROC) curves.
Results:
Patients were stratified into two groups based on their Precise DAPT score: high score (≥ 25) and low score (< 25). After a mean follow-up of 54.3 months, those in the high-score group exhibited significantly higher long-term all-cause mortality (36.3% vs. 6.1%, p < 0.001) and major stroke events (18.6% vs. 9.1%, p = 0.01). The high-score group also had worse renal function and were older. A multivariable Cox regression model demonstrated that the Precise DAPT score ≥ 25 was associated with long-term mortality (adjusted HR 4.82, 95% CI 2.75-8.45, p < 0.001) and major stroke (adjusted HR 2.11, 95% CI 1.14-3.92, p = 0.018).
Conclusions:
The Precise DAPT score, despite being designed for PCI patients, is a valuable prognostic tool in patients undergoing CAS. It is independently associated with both long-term mortality and major stroke, highlighting its potential to guide personalized therapeutic strategies. These findings suggest that integrating the Precise DAPT score into clinical practice may enhance the management of patients undergoing carotid interventions, particularly in risk stratification for bleeding and ischemic events.
