DAPT Score and the Impact of Ticagrelor Monotherapy During the Second Year After PCI.,JACC: Cardiovascular Interventions

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DAPT Score and the Impact of Ticagrelor Monotherapy During the Second Year After PCI.
JACC: Cardiovascular Interventions ( IF 11.7 ) Pub Date : 2020-03-02 , DOI: 10.1016/j.jcin.2019.12.018
Ply Chichareon ₁ , Rodrigo Modolo ₂ , Hideyuki Kawashima ₃ , Kuniaki Takahashi ₃ , Norihiro Kogame ₃ , Chun-Chin Chang ₄ , Mariusz Tomaniak ₅ , Masafumi Ono ₃ , Simon Walsh ₆ , Harry Suryapranata ₇ , James Cotton ₈ , Rene Koning ₉ , Ibrahim Akin ₁₀ , Neville Kukreja ₁₁ , Joanna Wykrzykowska ₃ , Jan J Piek ₃ , Scot Garg ₁₂ , Christian Hamm ₁₃ , Philippe Gabriel Steg ₁₄ , Peter Jüni ₁₅ , Pascal Vranckx ₁₆ , Marco Valgimigli ₁₇ , Stephan Windecker ₁₇ , Yoshinobu Onuma ₁₈ , Patrick W Serruys ₁₉

Affiliation

Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Internal Medicine, Cardiology Division, University of Campinas, Campinas, Brazil.
Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Department of Interventional Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands.
Department of Interventional Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Department of Cardiology, Belfast Health and Social Care Trust, Belfast, United Kingdom.
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom.
Cardiology Service, Clinique Saint-Hilaire, Rouen, France.
First Department of Medicine, University Medical Centre Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience and German Center for Cardiovascular Research Partner Site Heidelberg/Mannheim, Mannheim, Germany.
Department of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom.
Department of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom.
Kerckhoff Heart Center, University of Giessen, Bad Nauheim, Germany.
French Alliance for Cardiovascular Trials, INSERM U-1148, Hôpital Bichat, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France; Imperial College and the Institute of Cardiovascular Medicine and Science, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom.
Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, National University of Ireland, Galway, Galway, Ireland.
Department of Cardiology, National University of Ireland, Galway, Galway, Ireland; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.

Objectives

This study assessed the ability of the dual-antiplatelet therapy (DAPT) score in stratifying ischemic and bleeding risk in a contemporary percutaneous coronary intervention (PCI) population.

Background

The DAPT score is recommended by guidelines as a tool to stratify ischemic and bleeding risk. Its utility in contemporary PCI is unknown.

Methods

The study studied patients in GLOBAL LEADERS (A Clinical Study Comparing Two Forms of Anti-platelet Therapy After Stent Implantation) who were free of major ischemic and bleeding events and adhered to antiplatelet strategy during the first year after PCI. The primary ischemic endpoint was the composite of myocardial infarction or stent thrombosis. The primary bleeding endpoint was Bleeding Academic Research Consortium type 3 or 5. Outcomes from 12 to 24 months after PCI were compared according to the DAPT score.

Results

Of 11,289 patients that were event-free after the first year, 6,882 and 4,407 patients had low (<2) and high (≥2) DAPT scores, respectively. Compared with a low DAPT score, patients with a high DAPT score had a higher rate of the composites of myocardial infarction or stent thrombosis (0.70% vs. 1.55%; p < 0.0001). The rate of Bleeding Academic Research Consortium type 3 or 5 bleeding was 0.54% and 0.30% in the low and high DAPT score groups, respectively (p = 0.058). The effect of ticagrelor versus aspirin monotherapy on primary ischemic and bleeding endpoints during the second year were no different among the 2 groups.

Conclusions

The DAPT score can stratify ischemic but not bleeding risk in a contemporary PCI population during the second year. The score did not provide additional value for selection of antiplatelet strategy beyond the first year.

中文翻译：

PCI术后第二年的DAPT评分和替卡格雷单一疗法的影响。

目标

这项研究评估了双重抗血小板治疗（DAPT）评分在当代经皮冠状动脉介入治疗（PCI）人群中分层缺血和出血风险的能力。

背景

指南建议将DAPT评分作为对缺血和出血风险进行分层的工具。它在当代PCI中的效用尚不清楚。

方法

该研究研究了全球领先者（一项比较两种支架植入后抗血小板疗法的临床研究）的患者，这些患者无重大缺血和出血事件，并且在PCI后的第一年坚持抗血小板策略。主要的缺血终点是心肌梗塞或支架血栓形成的复合物。主要的出血终点是Bleeding Academic Research Consortium类型3或5。根据DAPT评分比较PCI后12到24个月的结果。

结果

在第一年后无事件的11289名患者中，分别有6882名和4407名患者的DAPT得分低（<2）和高（≥2）。与低DAPT分数相比，高DAPT分数的患者心肌梗死或支架内血栓形成的发生率更高（0.70％比1.55％； p <0.0001）。在低和高DAPT评分组中，Bleeding Academic Research Consortium 3型或5型出血的发生率分别为0.54％和0.30％（p = 0.058）。替卡格雷或阿司匹林单一疗法对第二年的主要缺血和出血终点的影响在两组之间没有差异。