From Bern University Hospital, Bern, Switzerland; Federico II University, Naples, Italy; University of Perugia, Perugia, Italy; and Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy.
Ann Intern Med. 2017 Jul 4;167(1):17-25. doi: 10.7326/M16-2389. Epub 2017 Jun 13.
The dual-antiplatelet therapy (DAPT) score was developed to identify patients more likely to derive harm (score <2) or benefit (score ≥2) from prolonged DAPT after percutaneous coronary intervention (PCI).
To evaluate the safety and efficacy of DAPT duration according to DAPT score.
Retrospective assessment of DAPT score-guided treatment duration in a randomized clinical trial. (ClinicalTrials.gov: NCT00611286).
PCI patients.
1970 patients undergoing PCI.
DAPT (aspirin and clopidogrel) for 24 versus 6 months.
Primary efficacy outcomes were death, myocardial infarction, or cerebrovascular accident. The primary safety outcome was type 3 or 5 bleeding according to the Bleeding Academic Research Consortium definition. Outcomes were assessed between 6 and 24 months.
884 patients (44.9%) had a DAPT score of at least 2, and 1086 (55.1%) had a score less than 2. The reduction in the primary efficacy outcome with 24- versus 6-month DAPT was greater in patients with high scores (risk difference [RD] for score ≥2, -2.05 percentage points [95% CI, -5.04 to 0.95 percentage points]; RD for score <2, 2.91 percentage points [CI, -0.43 to 6.25 percentage points]; P = 0.030). However, the difference by score for the primary efficacy outcome varied by stent type; prolonged DAPT with high scores was effective only in patients receiving paclitaxel-eluting stents (RD, -7.55 percentage points [CI, -12.85 to -2.25 percentage points]). The increase in the primary safety outcome with 24- versus 6-month DAPT was greater in patients with low scores (RD for score ≥2, 0.20 percentage point [CI, -1.20 to 1.60 percentage points]; RD for score <2, 2.58 percentage points [CI, 0.71 to 4.46 percentage points]; P = 0.046).
Retrospective calculation of the DAPT score.
Prolonged DAPT resulted in harm in patients with low DAPT scores undergoing PCI but reduced risk for ischemic events in patients with high scores receiving paclitaxel-eluting stents. Whether prolonged DAPT benefits patients with high scores treated with contemporary drug-eluting stents requires further study.
None.
双联抗血小板治疗（DAPT）评分旨在确定经皮冠状动脉介入治疗（PCI）后更可能因延长 DAPT 而获益（评分≥2）或受损（评分＜2）的患者。
评估 DAPT 评分指导的 DAPT 持续时间的安全性和有效性。
随机临床试验中对 DAPT 评分指导的治疗持续时间进行的回顾性评估。（ClinicalTrials.gov：NCT00611286）。
PCI 患者。
1970 名接受 PCI 的患者。
DAPT（阿司匹林和氯吡格雷）持续 24 个月与 6 个月。
主要疗效终点为死亡、心肌梗死或脑血管意外。主要安全性终点为根据 Bleeding Academic Research Consortium 定义的 3 型或 5 型出血。在 6 至 24 个月时评估结局。
884 名患者（44.9%）的 DAPT 评分至少为 2，1086 名患者（55.1%）的评分小于 2。与 6 个月 DAPT 相比，高评分患者（评分≥2 的风险差异[RD]，-2.05 个百分点[95%CI，-5.04 至 0.95 个百分点]；评分＜2 的 RD，2.91 个百分点[CI，-0.43 至 6.25 个百分点]；P=0.030）接受 24 个月 DAPT 可降低主要疗效终点事件的发生率。然而，评分对主要疗效终点的影响因支架类型而异；在接受紫杉醇洗脱支架治疗的患者中，高评分患者延长 DAPT 是有效的（RD，-7.55 个百分点[95%CI，-12.85 至 -2.25 个百分点]）。与 6 个月 DAPT 相比，低评分患者（评分≥2 的 RD，0.20 个百分点[95%CI，-1.20 至 1.60 个百分点]；评分＜2 的 RD，2.58 个百分点[95%CI，0.71 至 4.46 个百分点]；P=0.046）接受 24 个月 DAPT 会增加主要安全性终点事件的发生率。
DAPT 评分的回顾性计算。
在接受 PCI 的低 DAPT 评分患者中，延长 DAPT 会导致损伤，但在接受紫杉醇洗脱支架治疗的高评分患者中可降低缺血事件风险。接受当代药物洗脱支架治疗的高评分患者是否能从延长 DAPT 中获益，尚需进一步研究。
无。
