Validating Utility of Dual Antiplatelet Therapy Score in a Large Pooled Cohort From 3 Japanese Percutaneous Coronary Intervention Studies.
BACKGROUND
The dual antiplatelet therapy (DAPT) score was developed to estimate ischemic and bleeding risks from the DAPT study. However, few studies validated its utility externally. We sought to validate the utility of the DAPT score in the Japanese population.


METHODS
In a pooled cohort of 3 studies conducted in Japan (the CREDO-Kyoto [Coronary Revascularization Demonstrating Outcome Study in Kyoto] Registry Cohort-2, RESET [Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial], and NEXT [NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial]), we compared risks for ischemic and bleeding events from 13 to 36 months after percutaneous coronary intervention among patients with a DAPT score ≥2 (high DS) and a DAPT score <2 (low DS).


RESULTS
Among 12 223 patients receiving drug-eluting stents who were free from ischemic or bleeding events at 13 months after percutaneous coronary intervention, 3944 patients had high DS and 8279 had low DS. The cumulative incidence of primary ischemic end point (myocardial infarction/stent thrombosis) was significantly higher in high DS than in low DS (1.5% versus 0.9%, P=0.002), whereas the cumulative incidence of primary bleeding end point (GUSTO moderate/severe) tended to be lower in high DS than in low DS (2.1% versus 2.7%, P=0.07). The cumulative incidences of cardiac death, myocardial infarction, and stent thrombosis were also significantly higher in high DS than in low DS (2.0% versus 1.4%, P=0.03; 1.5% versus 0.8%, P=0.002; 0.7% versus 0.3%, P<0.001, respectively), whereas the cumulative incidences of noncardiac death and GUSTO severe bleeding were significantly lower in high DS than in low DS (2.4% versus 3.9%, P<0.001; 1.0% versus 1.6%, P=0.03, respectively).


CONCLUSIONS
In the current population, the DAPT score successfully stratified ischemic and bleeding risks, although the ischemic event rate was remarkably low even in high DS. Further studies would be warranted to evaluate the utility of prolonged DAPT guided by the DAPT score.
['Yoshikawa|Yusuke|Y|', 'Shiomi|Hiroki|H|', 'Watanabe|Hirotoshi|H|', 'Natsuaki|Masahiro|M|', 'Kondo|Hirokazu|H|', 'Tamura|Toshihiro|T|', 'Nakagawa|Yoshihisa|Y|', 'Morimoto|Takeshi|T|', 'Kimura|Takeshi|T|']
D000367:Age Factors D000368:Aged D000789:Angina, Unstable D000066491:Clinical Decision-Making D015897:Comorbidity D003324:Coronary Artery Disease D003328:Coronary Thrombosis D003661:Decision Support Techniques D004359:Drug Therapy, Combination D054855:Drug-Eluting Stents D005260:Female D006304:Health Status D006470:Hemorrhage D006801:Humans D015994:Incidence D007564:Japan D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D018579:Patient Selection D062645:Percutaneous Coronary Intervention D010975:Platelet Aggregation Inhibitors D011237:Predictive Value of Tests D016032:Randomized Controlled Trials as Topic D012008:Recurrence D012042:Registries D015203:Reproducibility of Results D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome
dual antiplatelet therapy percutaneous coronary intervention DAPT score drug-eluting stent