Key result
DAPT score shows poor discrimination for ischemic events and major bleeding in real-world practice.
Why the study?
The DAPT score guides DAPT duration decisions after coronary stenting by predicting ischemic and bleeding risk, and this study sought to assess its performance in a nationwide real-world population.
Does the DAPT score adequately discriminate ischemic and bleeding risk from months 12 to 30 after coronary stenting in a nationwide real-world population?
Cohort (n=41,101)
Yes
Does the DAPT score adequately discriminate ischemic and bleeding risk from months 12 to 30 after coronary stenting in a nationwide real-world population?
In a large nationwide Swedish cohort, the DAPT score demonstrated poor discrimination for both ischemic and bleeding risks, suggesting it may not be generalizable for guiding extended DAPT decisions in real-world populations.
Answers are grounded in this paper and cite their sources.
Limited utility of the DAPT score for guiding extended dual antiplatelet therapy; challenges prior recommendations and leaves open the search for superior predictive models.
BACKGROUND The dual antiplatelet therapy (DAPT) score guides decisions on DAPT duration after coronary stenting by simultaneously predicting ischemic and bleeding risk. OBJECTIVES This study sought to assess the performance of the DAPT score in a nationwide real-world population. METHODS The study used register data in Sweden (2006 to 2014) and followed 41,101 patients who had undergone 12 months of event-free DAPT, from months 12 to 30 after stenting. Risk of myocardial infarction (MI) or stent thrombosis, major adverse cardiovascular and cerebrovascular events (MACCE) (MI, stroke, and all-cause death), and fatal or major bleeding were compared according to DAPT score. RESULTS The score had a discrimination of 0.58 (95% confidence interval [CI]: 0.56 to 0.60) for MI or stent thrombosis, 0.54 (95% CI: 0.53 to 0.55) for MACCE, and 0.49 (95% CI: 0.45 to 0.53) for fatal or major bleeding. Risk of MI or stent thrombosis was significantly increased at scores of ≥3 while MACCE risk followed a J-shaped pattern and increased at scores of ≥4. Absolute differences in fatal or major bleeding risk were small between scores. Event rates of ischemic and bleeding outcomes in patients with high (≥2) and low (<2) scores differed compared to the DAPT Study from which the score was derived; fatal or major bleeding rates were approximately one-half of those in the placebo arm of the DAPT Study. CONCLUSIONS In a nationwide population, the DAPT score did not adequately discriminate ischemic and bleeding risk, the relationship between score and ischemic risk did not correspond to the suggested decision rule for extended DAPT, and risk of bleeding was lower compared with the DAPT Study. The score and its decision rule may not be generalizable to real-world populations.
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Ueda et al. (2018) conducted a cohort in Coronary stenting on dual antiplatelet therapy (DAPT) (n=41,101). High DAPT score (≥2) vs. Low DAPT score (<2) was evaluated on Myocardial infarction (MI) or stent thrombosis, MACCE (MI, stroke, all-cause death), and fatal or major bleeding (C-statistic 0.58 (MI/stent thrombosis), 0.54 (MACCE), 0.49 (bleeding), 95% CI 0.56-0.60). The DAPT score showed poor discrimination for MI/stent thrombosis, MACCE, and major bleeding in a nationwide real-world cohort.
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