Author + information
- Yusuke Yoshikawa,
- Hiroki Shiomi,
- Hirotoshi Watanabe,
- Masahiro Natsuaki,
- Hirokazu Kondo,
- Toshihiro Tamura,
- Takeshi Morimoto,
- Yoshihisa Nakagawa and
- Takeshi Kimura
Background: Dual antiplatelet therapy (DAPT) score has recently been proposed as a decision making tool for optimal duration of DAPT. However, its performance in predicting ischemic and bleeding events has not been adequately evaluated outside the Western countries.
Methods: The current study population consisted of 12941 patients who underwent drug-eluting stent (DES) implantation and received DAPT at discharge in the pooled cohort of the CREDO-Kyoto cohort-2, RESET and NEXT trials. We conducted a 13-month landmark analysis and compared the risks for ischemic (myocardial infarction and stent thrombosis) and major bleeding events between the 2 groups with DAPT score ≥2 (high ischemic risk) and <2 (high bleeding risk). Further, to evaluate the efficacy of prolonged DAPT, we compared the 5-year clinical outcomes between patients taking DAPT (on-DAPT) and those without (off-DAPT) at the landmark point, in the 2 groups stratified by DAPT score.
Results: 9371 patients were free from ischemic and bleeding event and continued DAPT at the 13-month landmark point. Patients with DAPT score <2 (N=6222) predominated over those with DAPT score ≥2 (N=3149). The cumulative 5-year incidence of the ischemic events was significantly higher in DAPT score ≥2 than in DAPT score <2 (3.0% vs. 2.3%, Log-rank P=0.003), while that of bleeding events was significantly lower in DAPT score ≥2 than in DAPT score <2 (5.1% vs. 6.0%, Log-rank P=0.03). In the group of DAPT score ≥2, the adjusted risks of on-DAPT (N=3149) relative to off-DAPT (N=795) for the ischemic and bleeding events were not significant (HR 0.95 [95%CI 0.61-1.53], P=0.82, and HR 1.07 [95%CI 0.73-1.62], P=0.72, respectively). In the group of DAPT score <2, the adjusted risks of on-DAPT (N=6222) relative to off-DAPT (N=2057) for the ischemic and bleeding events were not significant, either (HR 0.71 [95%CI 0.51-1.01], P=0.054, and HR 1.17 [95%CI 0.93-1.48], P=0.19, respectively).
Conclusions: The DAPT score categories were associated with the ischemic and bleeding events in Japanese patients after DES implantation. However, the DAPT status at 13 months did not affect the 5-year risks for both ischemic and bleeding events regardless of the DAPT score categories.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1296-305
- 2017 American College of Cardiology Foundation