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External Validation of the DAPT Score in a Nationwide Population
Karolinska Inst, Sweden.
Karolinska Inst, Sweden.
Uppsala Univ, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
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2018 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 72, no 10, p. 1069-1078Article in journal (Refereed) Published
Abstract [en]

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 amp;gt;= 3 while MACCE risk followed a J-shaped pattern and increased at scores of amp;gt;= 4. Absolute differences in fatal or major bleeding risk were small between scores. Event rates of ischemic and bleeding outcomes in patients with high (amp;gt;= 2) and low (amp;lt; 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. (C) 2018 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC , 2018. Vol. 72, no 10, p. 1069-1078
Keywords [en]
bleeding; dual antiplatelet therapy; myocardial infarction; risk prediction; risk score
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-151186DOI: 10.1016/j.jacc.2018.06.023ISI: 000442756300001PubMedID: 30158058OAI: oai:DiVA.org:liu-151186DiVA, id: diva2:1248624
Note

Funding Agencies|Stiftelsen for alderssjukdomar, Karolinska Institutet; AstraZeneca; Janssen; Bayer; Medicines Company; Novartis; Merck; Sanofi; Abbott

Available from: 2018-09-17 Created: 2018-09-17 Last updated: 2018-09-17

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Alfredsson, Joakim
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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