Validation of the DAPT score in real-world patients undergoing coronary stent implantation

• Published in: International journal of cardiology 2020-02, Vol.300, p.99-105
• Main Authors: Witberg, Guy, Zusman, Oren, Bental, Tamir, Plakht, Igal, Gabbay, Hagit, Gerber, Yariv, Kornowski, Ran
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aspirin - administration & dosage; Cohort Studies; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - drug therapy; Coronary Artery Disease - surgery; DAPT score; Drug-Eluting Stents; Dual Anti-Platelet Therapy - adverse effects; Dual Anti-Platelet Therapy - methods; Dual antiplatelet therapy; Female; Humans; Male; Middle Aged; PCI; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - methods; Platelet Aggregation Inhibitors - administration & dosage; Prospective Studies; Reproducibility of Results; Retrospective Studies
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2019.08.044

To assess the external validity of the Dual Antiplatelet Therapy (DAPT) score decision tool in real world patients. Retrospective study using an all comers PCI registry. We compared the rates of myocardial infarction (MI) and actionable bleeding between 12 vs. 12+ months DAPT stratified by DAPT score category. Of 12,162 patients, 4471 (36.8%) completed a year of DAPT without events. The high DAPT score stratum patients were older and had a higher comorbidity burden. Overall, 12+ months DAPT duration was associated with reduced rates of MI (2.8% vs. 4.0%, p = 0.025) and similar rates of bleeding (2.6% vs. 1.9%, p = 0.281) compared to 12 months DAPT, but when stratified by DAPT score stratum, there was no difference in any of the outcomes in both high score group, (3.7% vs. 5.3%, p = 0.111 and 2.0% vs. 1.8%, p = 0.800, for MI and bleeding, respectively) and low score patients (2.7% vs. 3.1%, p = 0.656 and 2.8% vs. 2.0%, p = 0.308, for MI and bleeding, respectively). Overall clinical events (MI + bleeding) was again similar between patients treated with 12+ vs. 12 months DAPT (5.5% vs. 6.2%, p = 0.535 and 5.1% vs. 4.4%, p = 0.503 for high and low DAPT score, respectively). for real world patients completing 1 year of DAPT post PCI, rates of MI, actionable bleeding, and their combination did not differ between those treated with 12+ vs. 12 months DAPT stratified by DAPT score stratum. Clinicians should be aware of the DAPT score's limitations. Further studies examining the validity of the DAPT score in larger cohorts are required. •The external validity of the DAPT score has been disappointing.•In our study the DAPT score was relevant for use in 36% of patients 1 year post PCI.•The event rate for bleeding and ischaemia was similar to that of the DAPT trial.•The DAPT score could not identify patients more suitable for extended DAPT duration.