Validation of the Asian-Dual Antiplatelet Therapy Score

Area of Science:

• Cardiology
• Pharmacology
• Clinical Research

Background:

• Dual antiplatelet therapy (DAPT) is crucial after percutaneous coronary intervention (PCI).
• Individualized DAPT prescribing is recommended to balance ischemic and bleeding risks.
• Asian-specific risk scores, like the Asian-DAPT (ADAPT) scores, were developed to address unique population profiles.

Purpose of the Study:

• To validate the predictive accuracy of the ADAPT scores for ischemic and bleeding events.
• To assess the utility of ischemic-ADAPT (I-ADAPT), bleeding-ADAPT (B-ADAPT), and Net-ADAPT scores in a real-world Asian cohort.
• To confirm the applicability of these scores in guiding DAPT duration and intensity.

Main Methods:

• Analysis of patients from the Multicenter Registry of KOrean PCI foR Endpoint Analysis (KOREAN-PCI).
• Calculation of I-ADAPT, B-ADAPT, and Net-ADAPT scores using clinical and angiographic data.
• Evaluation of co-primary endpoints: ischemic outcomes (cardiovascular death, MI, stent thrombosis) and bleeding outcomes (major/minor bleeding).

Main Results:

• The study included 4,657 patients with a median follow-up of 368 days.
• Ischemic and bleeding events occurred in 0.9% of patients each.
• Both I-ADAPT and B-ADAPT scores demonstrated significant predictive value for their respective outcomes (C-statistics 0.672 and 0.715).
• Net-ADAPT scores indicated increased risk: >0 for ischemic events (1.7-fold), <0 for bleeding events (1.3-fold).

Conclusions:

• The ADAPT scores are validated for predicting ischemic and bleeding risks in East Asian patients on DAPT.
• These scores provide a valuable tool for risk stratification and personalized DAPT management.
• The findings highlight the importance of population-specific risk assessment in cardiovascular pharmacotherapy.