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External Validation of the DAPT Score in a Nationwide Population

Ueda, Peter (author)
Karolinska Institute,Karolinska Institutet,Karolinska Inst, Sweden
Jernberg, Tomas (author)
Karolinska Institute,Karolinska Institutet,Karolinska Inst, Sweden,Danderyd Hospital
James, Stefan K, 1964- (author)
Uppsala University,Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR),Uppsala Univ, Sweden
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Alfredsson, Joakim (author)
Linköping University,Linköpings universitet,Avdelningen för kardiovaskulär medicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US
Erlinge, David (author)
Lund University,Lunds universitet,Molekylär kardiologi,Forskargrupper vid Lunds universitet,Molecular Cardiology,Lund University Research Groups,Skåne University Hospital
Omerovic, Elmir, 1968 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
Persson, Jonas (author)
Karolinska Institute,Karolinska Institutet,Karolinska Inst, Sweden,Danderyd Hospital
Ravn-Fischer, Annica, 1974 (author)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
Tornvall, Per (author)
Karolinska Institute,Karolinska Institutet,Karolinska Inst, Sweden,Stockholm South General Hospital
Svennblad, Bodil (author)
Uppsala University,Uppsala universitet,Ortopedi,Uppsala Univ, Uppsala Clin Res Ctr, Uppsala, Sweden,Epihubben
Varenhorst, Christoph, 1977- (author)
Uppsala University,Uppsala universitet,Kardiologi,Pfizer AB, Sollentuna, Sweden,Uppsala Univ, Sweden; Pfizer AB, Sweden,Pfizer Inc. US
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 (creator_code:org_t)
ELSEVIER SCIENCE INC, 2018
2018
English.
In: Journal of the American College of Cardiology. - : ELSEVIER SCIENCE INC. - 0735-1097 .- 1558-3597. ; 72:10, s. 1069-1078
  • Journal article (peer-reviewed)
Abstract Subject headings
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  • 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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

bleeding
dual antiplatelet therapy
myocardial infarction
risk prediction
risk score
bleeding
dual antiplatelet therapy
myocardial infarction
risk prediction
risk score

Publication and Content Type

ref (subject category)
art (subject category)

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