Validation of the DAPT score in patients randomized to 6 or 12 months clopidogrel after predominantly second-generation drug-eluting stents

Yukinori Harada; Jonathan Michel; Raphaela Lohaus; Katharina Mayer; Roberto Emmer; Anna Lena Lahmann; Roisin Colleran; Daniele Giacoppo; Annabelle Wolk; Jurrien M. ten Berg; Franz-Josef Neumann; Yaling Han; Tom Adriaenssens; Ralph Tölg; Melchior Seyfarth; Michael Maeng; Bernhard Zrenner; Claudius Jacobshagen; Jochen Wöhrle; Sebastian Kufner; Tanja Morath; Tareq Ibrahim; Isabell Bernlochner; Marcus Fischer; Heribert Schunkert; Karl-Ludwig Laugwitz; Julinda Mehilli; Robert A. Byrne; Adnan Kastrati; Stefanie Schulz-Schüpke

doi:10.1160/TH17-02-0101

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(10): 1989-1999
DOI: 10.1160/TH17-02-0101

Atherosclerosis and Ischaemic Disease

Schattauer GmbH

Validation of the DAPT score in patients randomized to 6 or 12 months clopidogrel after predominantly second-generation drug-eluting stents

Yukinori Harada

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Jonathan Michel

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Raphaela Lohaus

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Katharina Mayer

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Roberto Emmer

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Anna Lena Lahmann

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Roisin Colleran

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Daniele Giacoppo

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Annabelle Wolk

²Klinik für Kardiologie und Pneumologie Herzzentrum Göttingen der Georg-August-Universität, Goettingen, Germany

,

Jurrien M. ten Berg

³St. Antonius Hospital, Nieuwegein, Netherlands

,

Franz-Josef Neumann

⁴Universitäts-Herzzentrum Freiburg – Bad Krozingen, Bad Krozingen, Germany

,

Yaling Han

⁵Shenyang Northern Hospital, Shenyang, China

,

Tom Adriaenssens

⁶University Hospital Leuven, Leuven, Belgium

,

Ralph Tölg

⁷Herzzentrum der Segeberger Kliniken Gruppe, Bad Segeberg, Germany

,

Melchior Seyfarth

⁸HELIOS Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany

,

Michael Maeng

⁹Aarhus University Hospital, Aarhus, Denmark

,

Bernhard Zrenner

¹⁰Krankenhaus Landshut-Achdorf, Landshut, Germany

,

Claudius Jacobshagen

²Klinik für Kardiologie und Pneumologie Herzzentrum Göttingen der Georg-August-Universität, Goettingen, Germany

,

Jochen Wöhrle

¹¹Universitätsklinikum Ulm, Ulm, Germany

,

Sebastian Kufner

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Tanja Morath

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Tareq Ibrahim

¹²1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany

,

Isabell Bernlochner

¹²1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany

,

Marcus Fischer

¹³Universitätsklinikum Regensburg, Regensburg, Germany

,

Heribert Schunkert

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

¹⁴DZHK, Partner Site Munich Heart Alliance

,

Karl-Ludwig Laugwitz

¹²1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany

¹⁴DZHK, Partner Site Munich Heart Alliance

,

Julinda Mehilli

¹⁴DZHK, Partner Site Munich Heart Alliance

¹⁵Munich University Clinic, Ludwig-Maximilians University, München, Germany

,

Robert A. Byrne

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

,

Adnan Kastrati

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

¹⁴DZHK, Partner Site Munich Heart Alliance

,

Stefanie Schulz-Schüpke

¹Deutsches Herzzentrum München, Technische Universität, München, Germany

¹⁴DZHK, Partner Site Munich Heart Alliance

› Author Affiliations

Abstract

Summary

The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups. Primary ischaemic (all-cause death, myocardial infarction, definite stent thrombosis or stroke) and bleeding (TIMI major or minor) outcomes were analyzed in the low and high DAPT score groups. Data of 3976 patients were available for DAPT score calculation. 2407 patients (60.5%) were classified in the low DAPT score group and 1569 patients (39.5%) in the high DAPT score group. In the low DAPT score group there were no significant differences between 6 and 12 months DAPT regarding ischaemic (1.0% vs. 1.4%, HR=0.74, 95% CI, 0.35–1.57; p=0.43) or bleeding outcomes (0.3% vs. 0.8%, HR=0.44, 95% CI, 0.13–1.42; p=0.17). In the high DAPT score group there were also no significant differences between 6 and 12 months DAPT regarding ischaemic (1.9% vs. 1.8%, HR=1.02, 95% CI, 0.49–2.14; p=0.96) or bleeding (0.3% vs. 0.5%, HR=0.51, 95% CI, 0.09–2.78; p=0.44) outcomes. In conclusion, the DAPT score failed to show a differential treatment effect in patients receiving 6 or 12 months DAPT after contemporary drug-eluting stent implantation.

Key words

Dual antiplatelet therapy - DAPT score - second-generation drug-eluting stent - stent thrombosis

Full Text

References

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