Abstract 17078: Baseline Risk Score and Interruption of Dual Antiplatelet Therapy Within One Year After Coronary Stents: The Dual Antiplatelet Therapy Study Results
Introduction: The Dual Antiplatelet Therapy (DAPT) Score, derived from baseline risk factors for ischemic or bleeding events, was developed as a decision tool to determine benefit or harm from dual antiplatelet therapy given beyond 12 months after coronary stenting. The relationship of the DAPT Score to incident ischemic and bleeding events and the relationship to therapy interruptions within the first 12 months after stenting is unknown.
Methods: The DAPT Study enrolled 25,682 patients eligible for at least 12 months of treatment with a thienopyridine and aspirin following coronary stenting. Endpoints included ischemic events- a composite of myocardial infarction (MI) or stent thrombosis, bleeding - GUSTO moderate or severe, and major adverse cardiovascular and cerebrovascular events (MACCE). Patients were separated into 2 groups according to median DAPT score. Any interruption of antiplatelet therapy was ascertained over the first 6 months. Unadjusted outcomes were compared according to DAPT Score group and interruption status.
Results: Among enrolled patients, the median DAPT score was 2. From enrollment through 12 months, ischemia was higher (3.7% vs. 2.0%, p<0.001) and bleeding lower (2.0% vs. 3.5%, p=0.014) for DAPT Score ≥2 vs. <2. Therapy interruption within 6 months occurred in 4% of subjects and did not differ by DAPT Score category. Compared with patients without interruption, patients who interrupted therapy had increased risk for ischemia and MACCE within both DAPT score groups (Figure).
Conclusions: Higher DAPT scores were associated with higher ischemic and lower bleeding rates within 1 year after coronary stenting in patients prescribed 12 months of dual antiplatelet therapy. Patients who interrupted therapy within 6 months had increased risk for ischemia and MACCE regardless of DAPT score status. Rates of ischemia were highest among high DAPT Score patients who interrupted therapy.
Author Disclosures: D.E. Cutlip: Research Grant; Modest; Medtronic, Boston Scientific, Celonova. D.J. Kereiakes: Research Grant; Modest; Sanofi. Research Grant; Significant; Abbott Vascular, Boston Scientific. Consultant/Advisory Board; Modest; Sanofi. Consultant/Advisory Board; Significant; Abbott Vascular, Boston Scientific. R.W. Yeh: Research Grant; Significant; Abiomed, Boston Scientific. Consultant/Advisory Board; Modest; Boston Scientific. Consultant/Advisory Board; Significant; Abbott. A.C. Stefanescu Schmidt: None. P. Steg: Research Grant; Significant; Sanofi, Servier, Merck. Consultant/Advisory Board; Modest; Amarin, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL-Behring, Daiichi-Sankyo, GlaxoSmithKline, Lilly, Merck, Janssen, Novartis, Pfizer, The Medicines Company, Regeneron, Roche, The Medicines Company. Consultant/Advisory Board; Significant; AstraZeneca, Sanofi, Servier. J.M. Massaro: Employment; Significant; Harvard Clinical Research Institute. W. Hsieh: None. L. Mauri: Research Grant; Modest; Boeringher Ingelheim, ReCor. Speakers Bureau; Modest; Astra Zeneca, Sanofi, Daiichi-Sankyo. Consultant/Advisory Board; Modest; Amgen, St. Jude Medical, Biotronik, Corvia.
- © 2016 by American Heart Association, Inc.