Dual-Antiplatelet Therapy Score May Predict Safety of Treatment After PCI

Patients with a high dual-antiplatelet therapy (DAPT) score are more likely to benefit from prolonged treatment after undergoing percutaneous coronary intervention (PCI), according to a recent study.

The retrospective study included 1970 patients who had undergone PCI and had received DAPT treatment (aspirin and clopidogrel). The researchers assessed the safety and efficacy of DAPT in patients with both high (2 or more) and low (less than 2) DAPT scores at 6-month and 24-month follow-up visits.
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Death, myocardial infarction, or cerebrovascular events were assessed as the primary efficacy outcomes. The primary safety outcome was type 3 or 5 bleeding defined using the Bleeding Academic Research Consortium definition.

A total of 884 patients (44.9%) had a high DAPT score, and 1086 (55.1%) had a low score.

Patients with a high DAPT score experienced a greater reduction in risk for the primary efficacy outcomes than those with a low score. However, the difference by score for the primary efficacy outcome varied by stent type, with 24-month therapy only effective for patients with a high DAPT score who received paclitaxel-eluting stents.

Patients with a low DAPT score had an increased risk for bleeding than patients with a high 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,” the researchers concluded. “Whether prolonged DAPT benefits patients with high scores treated with contemporary drug-eluting stents requires further study.”

—Melissa Weiss

Reference:

Piccolo R, Gargiulo G, Franzone A, et al. Use of dual-antiplatelet therapy score to guide treatment duration after percutaneous coronary intervention [published online June 13, 2017]. Annals of Intern Med. doi:10.7326/M16-2389.