Validating Utility of DAPT Score in a Large Pooled Cohort from Three Japanese PCI Studies
Background—The DAPT score was developed to estimate ischemic and bleeding risks from the DAPT (Dual Antiplatelet Therapy) study. However, few studies validated its utility externally. We sought to validate the utility of the DAPT score in Japanese population.
Methods—In a pooled cohort of three studies conducted in Japan (the CREDO Kyoto registry cohort-2, RESET and NEXT), we compared risks for ischemic and bleeding events from 13 to 36 months after percutaneous coronary intervention (PCI) between patients with DAPT score ≥2 (high-DS) and DAPT score <2 (low-DS).
Results—Among 12223 patients receiving drug-eluting stents who were free from ischemic or bleeding events at 13 months after PCI, there were 3944 patients with high-DS, and 8279 with low-DS. The cumulative incidence of primary ischemic end point (myocardial infarction/stent thrombosis) was significantly higher in high-DS than in low-DS (1.5% versus 0.9%, P=0.002), while the cumulative incidence of primary bleeding end point (GUSTO moderate/severe) tended to be lower in high-DS than in low-DS (2.1% versus 2.7%, P=0.07). The cumulative incidences of cardiac death, myocardial infarction and stent thrombosis were also significantly higher in high-DS than in low-DS (2.0% versus 1.4%, P=0.03; 1.5% versus 0.8%, P=0.002; 0.7% versus 0.3%, P<0.001, respectively), while the cumulative incidences of non-cardiac death and GUSTO severe bleeding were significantly lower in high-DS than in low-DS (2.4% versus 3.9%, P<0.001; 1.0% versus 1.6%, P=0.03, respectively).
Conclusions—In the current population, the DAPT score successfully stratified ischemic and bleeding risks, although the ischemic event rate was remarkably low even in high-DS. Further studies would be warranted to evaluate the utility of prolonged DAPT guided by the DAPT score.
- Received April 12, 2017.
- Revision received August 23, 2017.
- Accepted September 18, 2017.