NewYork-Presbyterian Brooklyn Methodist Hospital (S.J.B.).
NewYork-Presbyterian Hospital/Columbia University Medical Center (A.J.K., G.W.S.).
Circ Cardiovasc Interv. 2018 Oct;11(10):e006853. doi: 10.1161/CIRCINTERVENTIONS.118.006853.
BACKGROUND: The dual antiplatelet therapy (DAPT) risk score was developed from the DAPT trial to inform the optimal duration of DAPT after percutaneous coronary intervention. We assessed the performance of the DAPT score in the ADAPT-DES (Assessment of Dual AntiPlatelet Therapy with drug-eluting stents) all-comers registry and tested the utility of additional predictors of adverse events. METHODS AND RESULTS: Outcomes between 1 and 2 years were examined according to DAPT score ≥2 versus <2, adjusted for DAPT continuation as a time-dependent variable. To assess the incremental utility of variables not included in the DAPT score, baseline high platelet reactivity was added to the ischemia model, and high platelet reactivity, baseline hemoglobin, and warfarin use 1 year after percutaneous coronary intervention were added to the bleeding model. Among 8582 patients enrolled in ADAPT-DES, 5397 were event-free after 1 year. Between 1 and 2 years, ischemic (myocardial infarction or stent thrombosis) and bleeding events occurred in 75 (1.5%) and 124 (2.3%) patients, respectively. Patients with higher DAPT scores (≥2 versus <2) had higher rates of myocardial infarction or stent thrombosis (1.9% versus 1.1%; P=0.01) and similar rates of bleeding (2.2% versus 2.4%, respectively; P=0.79). For the prediction of myocardial infarction or stent thrombosis, bleeding and death, DAPT score ≥2 had sensitivities of 57%, 41%, and 56%, respectively; specificities of 58%, 57%, and 58%, respectively; positive predictive values of 1.9%, 2.2%, and 2.1%, respectively; and negative predictive values of 99%, 98%, and 99%, respectively. Addition of baseline high platelet reactivity to the DAPT score did not improve discrimination for ischemic events. Addition of high platelet reactivity and 2 other bleeding covariates to the DAPT score marginally improved discrimination. CONCLUSIONS: In ADAPT-DES, the DAPT score was predictive of ischemic events between 1 and 2 years after drug-eluting stents. Prediction of bleeding improved marginally after addition of variables not incorporated in the DAPT score.
背景：双联抗血小板治疗（DAPT）风险评分是从 DAPT 试验中开发出来的，用于告知经皮冠状动脉介入治疗后 DAPT 的最佳持续时间。我们评估了 DAPT 评分在 ADAPT-DES（药物洗脱支架的双重抗血小板治疗评估）所有患者登记处的表现，并测试了不良事件的其他预测因子的效用。
方法和结果：根据 DAPT 评分≥2 与<2，调整 DAPT 持续时间作为时间依赖性变量，检查 1 至 2 年内的结果。为了评估未包含在 DAPT 评分中的变量的增量效用，在缺血模型中添加基线高血小板反应性，在出血模型中添加高血小板反应性、基线血红蛋白和经皮冠状动脉介入治疗 1 年后使用华法林。在 ADAPT-DES 登记的 8582 名患者中，有 5397 名患者在 1 年后无事件发生。在 1 至 2 年内，分别有 75 例（1.5%）和 124 例（2.3%）患者发生缺血性（心肌梗死或支架血栓形成）和出血事件。DAPT 评分较高（≥2 与<2）的患者心肌梗死或支架血栓形成的发生率较高（1.9%与 1.1%；P=0.01），出血发生率相似（2.2%与 2.4%；P=0.79）。对于心肌梗死或支架血栓形成、出血和死亡的预测，DAPT 评分≥2 的敏感性分别为 57%、41%和 56%；特异性分别为 58%、57%和 58%；阳性预测值分别为 1.9%、2.2%和 2.1%；阴性预测值分别为 99%、98%和 99%。在 DAPT 评分中添加基线高血小板反应性并未提高缺血事件的区分度。在 DAPT 评分中添加高血小板反应性和另外 2 个出血协变量后，区分度略有提高。
结论：在 ADAPT-DES 中，DAPT 评分可预测药物洗脱支架后 1 至 2 年内的缺血事件。在 DAPT 评分中添加未包含的变量后，出血预测略有改善。
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