The DAPT score is a recently-proposed decision tool for guiding optimal duration of dual antiplatelet therapy (DAPT). It showed modest accuracy in prior derivation and validation cohorts of patients with ≥12 months DAPT. This study was aimed to evaluate the validity of the DAPT score in a cohort of patients with 6 or 12 months DAPT after implantation of predominantly second-generation drug-eluting stents. We analyzed data of patients enrolled in the ISAR-SAFE trial. Patients were classified into low (<2) or high (≥2) DAPT score groups. Primary ischaemic (all-cause death, myocardial infarction, definite stent thrombosis or stroke) and bleeding (TIMI major or minor) outcomes were analyzed in the low and high DAPT score groups. Data of 3976 patients were available for DAPT score calculation. 2407 patients (60.5 %) were classified in the low DAPT score group and 1569 patients (39.5 %) in the high DAPT score group. In the low DAPT score group there were no significant differences between 6 and 12 months DAPT regarding ischaemic (1.0 % vs. 1.4 %, HR=0.74, 95 % CI, 0.35-1.57; p=0.43) or bleeding outcomes (0.3 % vs. 0.8 %, HR=0.44, 95 % CI, 0.13-1.42; p=0.17). In the high DAPT score group there were also no significant differences between 6 and 12 months DAPT regarding ischaemic (1.9 % vs. 1.8 %, HR=1.02, 95 % CI, 0.49-2.14; p=0.96) or bleeding (0.3 % vs. 0.5 %, HR=0.51, 95 % CI, 0.09-2.78; p=0.44) outcomes. In conclusion, the DAPT score failed to show a differential treatment effect in patients receiving 6 or 12 months DAPT after contemporary drug-eluting stent implantation.

译文

DAPT评分是最近提出的用于指导双重抗血小板治疗 (DAPT) 最佳持续时间的决策工具。在 ≥ 12个月DAPT的患者的先前推导和验证队列中,它显示出适度的准确性。这项研究旨在评估DAPT评分在植入主要是第二代药物洗脱支架后6或12个月的DAPT患者队列中的有效性。我们分析了参加ISAR-SAFE试验的患者的数据。患者分为低 (<2) 或高 (≥ 2) DAPT评分组。在低和高DAPT评分组中分析了原发性缺血性 (全因死亡,心肌梗塞,明确的支架血栓形成或中风) 和出血 (TIMI主要或次要) 结局。3976例患者的数据可用于DAPT评分计算。低DAPT评分组2407例 (60.5   %),高DAPT评分组1569例 (39.5   %)。在低DAPT评分组中,DAPT在缺血 (1.0   % vs. 1.4   %,HR = 0.74,95   % CI,0.35-1.57; p = 0.43) 或出血结果 (0.3   % vs. 0.8   %,HR = 0.44,95  % CI,0.13-1.42; p = 0.17)。在高DAPT评分组中,在缺血 (1.9   % vs. 1.8   %,HR = 1.02,95   % CI,0.49-2.14; p = 0.96) 或出血 (0.3   % vs. 0.5   %,HR = 0.51,95% CI,0.09-2.78; p = 0.44) 结果。总之,在当代药物洗脱支架植入后接受6或12个月DAPT的患者中,DAPT评分未能显示出不同的治疗效果。

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