Author + information
- Received April 26, 2018
- Revision received May 31, 2018
- Accepted June 4, 2018
- Published online August 26, 2018.
- Peter Ueda, MD, PhDa,∗ (, )@karolinskainst,
- Tomas Jernberg, MD, PhDb,
- Stefan James, MD, PhDc,d,
- Joakim Alfredsson, MD, PhDe,f,
- David Erlinge, MD, PhDg,
- Elmir Omerovic, MD, PhDh,i,
- Jonas Persson, MD, PhDb,
- Annica Ravn-Fischer, MD, PhDi,
- Per Tornvall, MD, PhDj,
- Bodil Svennblad, PhDd and
- Christoph Varenhorst, MD, PhDc,k
- aClinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- bDivision of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
- cDepartment of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
- dUppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
- eDepartment of Cardiology, Linköping University, Linköping, Sweden
- fDepartment of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- gDepartment of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden
- hDepartment of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
- iDepartment of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- jDepartment of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- kPfizer AB, Sollentuna, Sweden
- ↵∗Address for correspondence:
Dr. Peter Ueda, Clinical Epidemiology Division, Department of Medicine, Solna, Eugeniahemmet, T2, Karolinska Institutet, 171 76 Stockholm, Sweden.
Background The dual antiplatelet therapy (DAPT) score guides decisions on DAPT duration after coronary stenting by simultaneously predicting ischemic and bleeding risk.
Objectives The 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.
This work was supported by Stiftelsen för ålderssjukdomar, Karolinska Institutet. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr. James has served on the advisory board for AstraZeneca and Bayer; has received institutional research grants from AstraZeneca; received research grants from Janssen and Bayer; and received grants and personal fees from The Medicines Company. Dr. Alfredsson has received lecture fees from AstraZeneca, Novartis, Merck, and Sanofi; served on the advisory board for Bristol-Myers Squibb, Sanofi, and Eli Lilly; and received grant support from AstraZeneca. Dr. Erlinge has received personal fees from AstraZeneca, during the conduct of the study. Dr. Omerovic has received grants from AstraZeneca and Abbott; and personal fees from AstraZeneca. Dr. Svennblad has received institutional grants from AstraZeneca. Dr. Varenhorst has received institutional grants and advisory board fees from AstraZeneca; and is after the conduct of this work but before the submission of this paper an employee of Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2018.
- Revision received May 31, 2018.
- Accepted June 4, 2018.
- 2018 American College of Cardiology Foundation
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