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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
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Jonathan Michel
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Raphaela Lohaus
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Katharina Mayer
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Roberto Emmer
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Anna Lena Lahmann
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Roisin Colleran
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Daniele Giacoppo
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Annabelle Wolk
2   Klinik für Kardiologie und Pneumologie Herzzentrum Göttingen der Georg-August-Universität, Goettingen, Germany
,
Jurrien M. ten Berg
3   St. Antonius Hospital, Nieuwegein, Netherlands
,
Franz-Josef Neumann
4   Universitäts-Herzzentrum Freiburg – Bad Krozingen, Bad Krozingen, Germany
,
Yaling Han
5   Shenyang Northern Hospital, Shenyang, China
,
Tom Adriaenssens
6   University Hospital Leuven, Leuven, Belgium
,
Ralph Tölg
7   Herzzentrum der Segeberger Kliniken Gruppe, Bad Segeberg, Germany
,
Melchior Seyfarth
8   HELIOS Universitätsklinikum Wuppertal, Witten/Herdecke University, Wuppertal, Germany
,
Michael Maeng
9   Aarhus University Hospital, Aarhus, Denmark
,
Bernhard Zrenner
10   Krankenhaus Landshut-Achdorf, Landshut, Germany
,
Claudius Jacobshagen
2   Klinik für Kardiologie und Pneumologie Herzzentrum Göttingen der Georg-August-Universität, Goettingen, Germany
,
Jochen Wöhrle
11   Universitätsklinikum Ulm, Ulm, Germany
,
Sebastian Kufner
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Tanja Morath
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Tareq Ibrahim
12   1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany
,
Isabell Bernlochner
12   1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany
,
Marcus Fischer
13   Universitätsklinikum Regensburg, Regensburg, Germany
,
Heribert Schunkert
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
14   DZHK, Partner Site Munich Heart Alliance
,
Karl-Ludwig Laugwitz
12   1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität, München, Germany
14   DZHK, Partner Site Munich Heart Alliance
,
Julinda Mehilli
14   DZHK, Partner Site Munich Heart Alliance
15   Munich University Clinic, Ludwig-Maximilians University, München, Germany
,
Robert A. Byrne
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
,
Adnan Kastrati
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
14   DZHK, Partner Site Munich Heart Alliance
,
Stefanie Schulz-Schüpke
1   Deutsches Herzzentrum München, Technische Universität, München, Germany
14   DZHK, Partner Site Munich Heart Alliance
› Author Affiliations Financial support: The trial was supported by the Bundesministerium für Bildung und Forschung (German Federal Ministry for Education and Research; grant number: FKZ 01KG0901) and an unrestricted research grant from Abbott Vascular.
Further Information

Publication History

Received: 13 February 2017

Accepted after major revision: 21 June 2017

Publication Date:
08 November 2017 (online)

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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
 

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