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External Validation of the DAPT Score in a Nationwide Population

Ueda, Peter; Jernberg, Tomas; James, Stefan; Alfredsson, Joakim; Erlinge, David LU ; Omerovic, Elmir; Persson, Jonas; Ravn-Fischer, Annica; Tornvall, Per and Svennblad, Bodil, et al. (2018) In Journal of the American College of Cardiology 72(10). p.1069-1078
Abstract

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... (More)

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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published
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keywords
bleeding, dual antiplatelet therapy, myocardial infarction, risk prediction, risk score
in
Journal of the American College of Cardiology
volume
72
issue
10
pages
10 pages
publisher
Elsevier USA
external identifiers
  • scopus:85053828687
ISSN
0735-1097
DOI
10.1016/j.jacc.2018.06.023
language
English
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yes
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ca48f84a-495b-496b-904d-073b554e62e2
date added to LUP
2018-10-12 08:38:53
date last changed
2019-11-05 05:04:14
@article{ca48f84a-495b-496b-904d-073b554e62e2,
  abstract     = {<p>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 (&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.</p>},
  author       = {Ueda, Peter and Jernberg, Tomas and James, Stefan and Alfredsson, Joakim and Erlinge, David and Omerovic, Elmir and Persson, Jonas and Ravn-Fischer, Annica and Tornvall, Per and Svennblad, Bodil and Varenhorst, Christoph},
  issn         = {0735-1097},
  keyword      = {bleeding,dual antiplatelet therapy,myocardial infarction,risk prediction,risk score},
  language     = {eng},
  month        = {09},
  number       = {10},
  pages        = {1069--1078},
  publisher    = {Elsevier USA},
  series       = {Journal of the American College of Cardiology},
  title        = {External Validation of the DAPT Score in a Nationwide Population},
  url          = {http://dx.doi.org/10.1016/j.jacc.2018.06.023},
  volume       = {72},
  year         = {2018},
}