Validation of contemporary risk scores in predicting coronary thrombotic events and major bleeding in patients with acute coronary syndrome after drug‐eluting stent implantations

Song, Li; Guan, Changdong; Yan, Hongbing; Qiao, Shubin; Wu, Yongjian; Yuan, Jinqing; Dou, Kefei; Yang, Yuejin; Dangas, George; Xu, Bo

doi:10.1002/ccd.27468

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…Our search of MEDLINE and EMBASE yielded 81 results (Figure 1). After detailed review of titles and abstracts and full manuscripts of potentially relevant papers a total of 13 studies were included 8,12‐16,18‐24 …”

Section: Resultsmentioning

confidence: 99%

“…The case‐control study by Godschalk et al reported a C‐statistic of 0.64 for the DAPT score and very late stent thrombosis 18 . Among Chinese patients in the Song et al study, the DAPT score had poor predictive value for major adverse cardiovascular events (stent thrombosis and myocardial infarction, c‐statistic 0.53) and major bleeding (c‐statistic 0.56) 23 . The Harrell's c‐statistic for DAPT score was 0.58 for myocardial infarction and stent thrombosis and 0.49 for fatal or major bleeding from the Swedish National Registry 18 .…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of the studies that evaluate the performance of the DAPT score

Kwok

Wong

Nagaraja

et al. 2020

Int. J. Clin. Pract.

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Background The Dual Antiplatelet Therapy (DAPT) score was derived to determine which patients may benefit from prolonged DAPT therapy after 12 months based on the balance between ischaemic and bleeding events. Several studies have attempted to validate the score with inconsistent findings. Methods We conducted a systematic review of the studies that evaluated the DAPT score in PCI populations. A search was performed on MEDLINE and EMBASE and two independent reviewers reviewed the search results for study inclusion and extracted data from studies which met the inclusion criteria. Data are presented in tables and narrative synthesis was performed. Results A total of 13 studies were included in this review. The study designs included post hoc analysis of randomised trials, prospective cohorts, retrospective cohorts and a case‐control study. In the derivation/validation study, the c‐statistic for ischaemic and bleeding outcomes were 0.64/0.70 and 0.68/0.64, respectively. Among the validation studies, the C‐statistics for composite outcomes ranged from 0.53 to 0.71 for ischaemic outcomes and 0.49 to 0.71 for bleeding outcomes. Only one study randomised patients with high DAPT score to different combinations of antiplatelet after 1 year of DAPT and found that continuation of DAPT was associated with fewer deaths because of myocardial infarction, but more bleeding. Conclusions While not designed for this purpose many studies have shown that the DAPT score has modest predictive value for ischaemic and bleeding outcomes. A prospective randomised controlled trial is needed to evaluate the clinical benefits of utilising the DAPT score in guiding continued DAPT therapy beyond 1 year.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A systematic review of the studies that evaluate the performance of the DAPT score

Kwok

Wong

Nagaraja

et al. 2020

Int. J. Clin. Pract.

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“…Risk scores such as the prediction rule models for DAPT, the Predicting complications in Patients undergoing stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE‐DAPT), and the Patterns of nonadherence to AntiPlatelet Regimen in Stented Patients are currently in widespread use. Nevertheless, these risk prediction models have not achieved consistent results in external validation studies . The GRACE score, as a universally recognized risk stratification tool for ischemia, has been validated in numerous studies since it was first proposed in 2004 .…”

Section: Discussionmentioning

confidence: 99%

Impact of extended dual antiplatelet therapy on clinical prognosis in acute coronary syndrome patients with intermediate or high ischemic risk defined by the GRACE score

Bian

Qiu

et al. 2020

Cathet Cardio Intervent

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Objectives To evaluate the impact of extended dual antiplatelet therapy (DAPT) beyond 12 months in acute coronary syndrome (ACS) patients with intermediate‐risk to high‐risk of developing ischemia according to the Global Acute Coronary Event Registration (GRACE) score. Background The duration of optimal DAPT remains controversial in patients at higher risk of developing ischemia. Methods Overall, 9,309 ACS patients in the Optimal antiPlatelet Therapy for Chinese patients with Coronary Artery Disease (OPT‐CAD) study were stratified as low‐risk ( n = 5,112) or intermediate‐risk to high‐risk (n = 4,197) according to the GRACE score on hospital discharge. Clinical outcomes at 12–24 months in patients with intermediate‐to‐high risk who completed 1‐year DAPT without any adverse events were analyzed. The primary endpoint was 24‐month net adverse clinical events (NACEs). Results Patients at intermediate‐to‐high‐risk had significantly higher incidence of NACE (10.2 vs. 4.9%, p < .01) and ischemic events (8.3 vs. 3.8%, p < .01) than low‐risk patients at 24 months. For patients at intermediate‐to‐high‐risk, extended DAPT beyond 12 months was associated with lower risk of NACE (3.0 vs. 5.1%, p = .012), all‐cause death (1.1 vs. 2.6%, p = .01), and cardiac death (0.6 vs. 1.8%, p = .01), without excessive risk of major bleeding events (0.3 vs. 0.5%, p = .47). Clinical outcomes in the propensity‐matched cohort were consistent. Conclusions ACS patients with intermediate‐risk or high‐ischemic risk may benefit from extended DAPT beyond 1 year, an outcome than requires further confirmation in large‐scale randomized trials.

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“…51,52 Hereafter, both the DAPT score and PARIS registry scores were retrospectively validated and compared in a Chinese population (n=5,709). 53 Only the DAPT score showed modest accuracy for predicting major bleedings. Both scores showed poor discriminative capacity predicting ischemic events.…”

Section: Patient-tailored Duration Of Dual Antiplatelet Therapymentioning

confidence: 99%

Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Is Less More?

Rozemeijer¹

2018

US Cardiology Review

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The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) using the latest-generation drug-eluting stents remains a matter of debate. Evidence suggests short regimens of DAPT are favorable for patients with a low ischemic risk, while those at a high risk of ischemia may benefit from taking DAPT for a long duration. An individually assessed risk profile is pivotal in guiding DAPT duration. Risk scores may aid individual patient DAPT decisions, but the value they add to clinical outcomes still needs to be established in a prospective randomized trial. This review aims to provide an overview on DAPT, evaluate the available evidence on DAPT duration with a description of common pitfalls of trial interpretation, and assess available tools for individual risk assessment in patients scheduled for PCI with the latest-generation DES.

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Validation of contemporary risk scores in predicting coronary thrombotic events and major bleeding in patients with acute coronary syndrome after drug‐eluting stent implantations

Abstract: The current three risk scores, derived and initially validated in Western populations, may not be applicable to the Chinese population, although DAPT score was determined to be a modestly accurate quantitative tool for prediction of later MB.

Cited by 21 publications

References 20 publications

A systematic review of the studies that evaluate the performance of the DAPT score

A systematic review of the studies that evaluate the performance of the DAPT score

Impact of extended dual antiplatelet therapy on clinical prognosis in acute coronary syndrome patients with intermediate or high ischemic risk defined by the GRACE score

Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: Is Less More?

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