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Tianhua Deng, Lin Huang, Zhengli Ran, Xun Huang, Hong Li, Zhigang You Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, People’s Republic of ChinaCorrespondence: Zhigang You, Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, No. 1 Minde Road, Nanchang, Jiangxi Province, 330006, People’s Republic of China, Tel +86 13077985297, Email youzhigang_75@126.comPurpose: The values of European Society of Cardiology (ESC) criteria and dual antiplatelet therapy (DAPT) score in the stratification of ischemic risk were assessed in this study.Methods: A total of 489 patients with acute coronary syndrome who received DAPT at discharge between June 2020 and August 2020 were enrolled. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), which included recurrent ACS or unplanned revascularization, all-cause death, or ischemic stroke during a 27-month follow-up period.Results: Patients with ESC-defined high-risk showed a significantly higher risk of MACE (HR 2.75, 95% CI 1.78– 4.25), all-cause death (HR 2.49, 95% CI 1.14– 5.43), and recurrent ACS or unplanned revascularization (HR 2.80, 95% CI 1.57– 4.99) than those with ESC-defined low/medium-risk during follow-up. The results of landmark analysis showed that patients in the high-risk group had a significantly higher risk of MACE (HR 2.80,95 CI% 1.57– 4.97), recurrent ACS or unplanned revascularization (HR 3.19,95 CI% 1.47– 6.93) within one year, and a higher risk of MACE (HR 2.69,95 CI% 1.38– 5.23) after one year. There was no significant difference in the incidence of MACE between patients with a DAPT score ≥ 2 and a DAPT score < 2. The C-indices of ESC criteria and DAPT score for prediction of MACE were 0.63 (95% CI 0.57– 0.70) and 0.54 (95% CI 0.48– 0.61), respectively. The predictive value of ESC criteria for MACE was better than the DAPT score according to the DeLong test (z-statistic=2.30, P=0.020).Conclusion: Patients with ESC-defined high-risk had a higher risk of MACE compared to those with ESC-defined low/medium-risk. The discriminant ability of the ESC criteria was better than the DAPT score for MACE. The ESC criteria demonstrated moderate discriminatory capacity of MACE in ACS patients treated with DAPT.Keywords: acute coronary syndrome, ESC criteria, DAPT score, platelet inhibitors, clinical outcome

Objectives: High thrombus burden (HTB) was an independent predictor of death, repeat myocardial infarction, and infarct-related artery intervention and stent thrombus in patients with acute myocardial infarction (AMI). This study aimed to evaluate the predictive role of the dual antiplatelet therapy (DAPT) score in the estimation of intracoronary thrombus burden in patients with AMI. Materials and Methods: Between March 2020 and May 2020, 360 consecutive patients admitted with AMI who underwent coronary angiography at the cardiology department of our institution were retrospectively evaluated. The DAPT score has been defined as previously in the DAPT study. The thrombolysis in myocardial infarction (TIMI) thrombus grade was calculated for each patient from the diagnostic angiographic images taken before percutaneous coronary interventions. HTB was defined as TIMI thrombus grades 4 and 5 calculated according to the TIMI thrombus grading scale. The study population was divided into two groups according to their TIMI thrombus grade: low thrombus burden (LTB) (TIMI 0-3) and HTB (TIMI 4 and 5). Results: There were 133 patients (36.9%) in the LT group and 227 patients (63.1%) in the HTB group. Patients with HTB had significantly a higher DAPT score (p=0.010) compared with LTB patients. The ability of the DAPT score to predict the HTB was evaluated by receiver operating characteristic curve analysis. The cut-off value of the DAPT score for predicting the HTB was 2 (with a sensitivity of 67.8%, specificity=69.4%) according to the Youden index. Univariate regression analysis demonstrated that the DAPT score was significantly associated with the HTB. On multivariate analysis, the DAPT score (Odds ratio: 1,245, 95% confidence interval: 1,009-1,537; p=0.041) was found as an independent predictor of the HTB when the DAPT score was analyzed as a continuous variable. Conclusion: The DAPT score is a practical score system to guide DAPT duration, accounting for both ischemic risk and bleeding risk factors. Considering the increasing number of patients with acute coronary syndromes, prediction of thrombus burden through a simple and practical scoring system may be of benefit. [ABSTRACT FROM AUTHOR]

Dual antiplatelet therapy (DAPT) score emerged as a tool for quantification of ischemia and bleeding risks. However, there was discrepancy of the prediction ability of DAPT score in previous studies. We aimed to assess the utility of DAPT score in a large-scale cohort of consecutive percutaneous coronary intervention (PCI) patients. This study enrolled 9,114 patients who had undergone PCI at Fuwai Hospital in 2013, adhered to DAPT and were event-free within the first 12 months following PCI. The endpoints included primary ischemic endpoints (major adverse cardiovascular and cerebrovascular events, and myocardial infarction and/or stent thrombosis), and bleeding endpoint from 12 through 24 months after PCI. Patients were classified into low (score

Background: Guidelines recommend individualization of dual antiplatelet therapy (DAPT) duration. Whether to guide decisions based on bleeding risk, ischemic risk or a combination is not known.Aims: To compare a bleeding prediction model, an ischemic prediction model, and the DAPT score in guiding DAPT duration.Methods: 11,648 patients in the DAPT Study were categorized into higher and lower risk using a bleeding model, an ischemic model, and the DAPT score. Effect of 30 vs. 12 months of DAPT on bleeding events, ischemic events, and the combination (net-adverse clinical events [NACE]) was assessed.Results: Among patients stratified with the bleeding model, 30 vs. 12 months of DAPT resulted in similar ischemic and bleeding event rates. With the ischemic model, however, higher risk patients had a greater reduction in ischemic events with extended duration of DAPT (difference in risk differences [DRD]: -2.6%, 95% CI: -3.9 to -1.3%; p < 0.01), and a smaller increase in bleeding (DRD: -1.0%, 95% CI: -2.1-0.0%; p = 0.04). Similarly, high DAPT score patients had a greater reduction in ischemic events with extended DAPT duration (DRD: -2.4%, 95%: CI: -3.6 to -1.1%; p < 0.01) and a smaller increase in bleeding (DRD: -1.2%, 95%: CI: -2.2-0.0%; p = 0.02). Although NACE was similar for bleeding risk groups, NACE was significantly reduced with extended DAPT in the higher ischemic risk and high DAPT score groups.Conclusions: In this low-bleeding risk population, stratifying patients based on predicted ischemic risk and the DAPT score best discerned benefit versus harm of extended DAPT duration on ischemic events, bleeding events, and NACE.Condensed Abstract: Duration of dual antiplatelet therapy (DAPT) should be guided by an individualized risk assessment. Bleeding risk tools have emerged to identify patients at high bleeding risk for whom truncated DAPT therapy may be safest. In a lower bleeding risk population, however, whether DAPT duration should be guided by bleeding risk, ischemic risk, or a combination is unknown. In this analysis, implementation of a score based on ischemic risk prediction and the DAPT score (a combination of ischemic and bleeding risk) best predicted ischemic events, bleeding events, and net-adverse clinical events (NACE). [ABSTRACT FROM AUTHOR]

BackgroundDual antiplatelet therapy (DAPT) score is used to stratify ischemic and bleeding risk for antiplatelet therapy after percutaneous coronary intervention (PCI). This study assessed the association between the DAPT score and clinical outcomes in acute coronary syndrome (ACS) patients who were treated with P2Y12 inhibitor monotherapy.MethodsA total of 498 ACS patients, with early aspirin discontinuation for various reasons and who received P2Y12 inhibitor monotherapy after PCI, were enrolled during the period from January 1, 2014 to December 31, 2018. The efficacy and safety between those with low (

Dual antiplatelet therapy (DAPT) score emerged as a tool for quantification of ischemia and bleeding risks. However, there was discrepancy of the prediction ability of DAPT score in previous studies. We aimed to assess the utility of DAPT score in a large-scale cohort of consecutive percutaneous coronary intervention (PCI) patients. This study enrolled 9,114 patients who had undergone PCI at Fuwai Hospital in 2013, adhered to DAPT and were event-free within the first 12 months following PCI. The endpoints included primary ischemic endpoints (major adverse cardiovascular and cerebrovascular events, and myocardial infarction and/or stent thrombosis), and bleeding endpoint from 12 through 24 months after PCI. Patients were classified into low (score <2, n = 3,989) and high (score ≥2, n = 5,125) DAPT score groups. The incidence rates of primary ischemic endpoints and bleeding endpoint were similar between the two groups. Multivariable analysis demonstrated DAPT score not to be an independent predictor of primary ischemic endpoints or bleeding endpoint. Based on receiver operating characteristic curves analysis, the C-statistic of DAPT score for primary ischemic endpoints or bleeding endpoint did not achieve a significant extent. In this large-scale cohort of PCI patients, DAPT score did not discriminate the risks of ischemic and bleeding events. [ABSTRACT FROM AUTHOR]

Introduction The optimal duration of dual anti-platelet therapy (DAPT) following percutaneous coronary intervention (PCI) is still a matter of debate. Biomarkers may help to identify patients who will benefit from extended DAPT. The aim of the study was to test the interaction between lipid parameters and platelet function in patients with coronary artery disease (CAD) on DAPT. Material and methods Overall, 58 patients on DAPT were prospectively included following PCI in stable CAD. Platelet markers, i.e. mean platelet volume (MPV), platelet distribution width (PDW), fraction of reticulated thrombocytes (RT) and ADP-induced multiple electrode aggregometry (MEA), as well as serum lipids, i.e. high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides (TG) and remnant cholesterol (RC), were assessed after intake of a maintenance dose of ASA and P2Y12 inhibitor. Results A significant inverse correlation was found for HDL-C levels and markers of platelet activation: MPV (r = –0.351, p = 0.009), PDW (r = –0.391, p = 0.003), fraction of RT (r = –0.402, p = 0.003) and ADP-induced MEA (r = –0.345, p = 0.011). Only a weak or no association was found between other lipid parameters and platelet markers. After multivariable adjustment, HDL-C levels served as a strong and significant predictor of MPV (95% CI: –0.039 to –0.009; p = 0.002), PDW (95% CI: –0.094 to –0.034; p < 0.0001), RT (95% CI: –0.107 to –0.031; p = 0.001) and MEA (95% CI: –0.540 to –0.170; p < 0.0001), while TG, LDL-C, RC and TC were not significantly associated with platelet function. Conclusions Within lipid parameters, only HDL-C levels are strongly associated with markers of platelet activation in CAD patients on DAPT. Accordingly, detection of dyslipidemia might indicate the need for prolongation of DAPT.

This study aims to evaluate the temporal changes in DAPT score and determine whether there is an association between DAPT score and mortality. We analyzed all patients who underwent PCI in England and Wales 2007-2014. Statistical analyses were performed evaluating the DAPT score according to ≥2 and <2 cutoffs. Trends in DAPT score and logistic regressions were used to determine the association between DAPT score and 30 day, 1 year and 3 year mortality. A total of 243,440 patients were included in the analysis and the proportion of patients with DAPT score ≥ 2 was 35.6% (n = 86,550). The trend in DAPT score ≥ 2 showed an overall decline over time from 38.5% in 2007 to 34.5% in 2014. In more recent years, patients were older and a greater proportion were diabetic and had myocardial infarction on presentation and there was a significant decline in patients receiving paclitaxel stent (23.7% in 2007 to 0.2% in 2014). Patients with DAPT score ≥ 2 were more likely to be male, have previous CABG and have glycoprotein IIB/IIIa inhibitors. At 3 year follow up there was a significant difference in death compared DAPT ≥ 2 vs <2 (5.2% vs 5.5%, p < 0.001). DAPT score ≥ 2 was associated with reduced mortality at 1 year (OR 0.87 95%CI 0.82-0.92, p < 0.001) and 3 years (OR 0.82 95%CI 0.79-0.86, p < 0.001) after adjustments. These findings suggest that the DAPT score classifies 1 in 3 patients as having scores ≥2 and these patients have reduced odds of long-term mortality. [ABSTRACT FROM AUTHOR]

The ideal duration of antiplatelet therapy following percutaneous coronary intervention is a topic of much discussion within the cardiology community. Numerous contemporary studies have highlighted benefits of both shortened and prolonged treatment courses within particular patient cohorts. Despite this, there is a delay in seeing such individualised decisions being made within stretched healthcare systems. We aimed to highlight this issue and facilitate discussions on how we can bring this important research from 'bench' to 'bedside'. [ABSTRACT FROM AUTHOR]

To assess the external validity of the Dual Antiplatelet Therapy (DAPT) score decision tool in real world patients. Retrospective study using an all comers PCI registry. We compared the rates of myocardial infarction (MI) and actionable bleeding between 12 vs. 12+ months DAPT stratified by DAPT score category. Of 12,162 patients, 4471 (36.8%) completed a year of DAPT without events. The high DAPT score stratum patients were older and had a higher comorbidity burden. Overall, 12+ months DAPT duration was associated with reduced rates of MI (2.8% vs. 4.0%, p = 0.025) and similar rates of bleeding (2.6% vs. 1.9%, p = 0.281) compared to 12 months DAPT, but when stratified by DAPT score stratum, there was no difference in any of the outcomes in both high score group, (3.7% vs. 5.3%, p = 0.111 and 2.0% vs. 1.8%, p = 0.800, for MI and bleeding, respectively) and low score patients (2.7% vs. 3.1%, p = 0.656 and 2.8% vs. 2.0%, p = 0.308, for MI and bleeding, respectively). Overall clinical events (MI + bleeding) was again similar between patients treated with 12+ vs. 12 months DAPT (5.5% vs. 6.2%, p = 0.535 and 5.1% vs. 4.4%, p = 0.503 for high and low DAPT score, respectively). for real world patients completing 1 year of DAPT post PCI, rates of MI, actionable bleeding, and their combination did not differ between those treated with 12+ vs. 12 months DAPT stratified by DAPT score stratum. Clinicians should be aware of the DAPT score's limitations. Further studies examining the validity of the DAPT score in larger cohorts are required. • The external validity of the DAPT score has been disappointing. • In our study the DAPT score was relevant for use in 36% of patients 1 year post PCI. • The event rate for bleeding and ischaemia was similar to that of the DAPT trial. • The DAPT score could not identify patients more suitable for extended DAPT duration. [ABSTRACT FROM AUTHOR]

Background: The dual antiplatelet therapy (DAPT) score was developed to estimate ischemic and bleeding risks from the DAPT study. However, few studies validated its utility externally. We sought to validate the utility of the DAPT score in the Japanese population.Methods: In a pooled cohort of 3 studies conducted in Japan (the CREDO-Kyoto [Coronary Revascularization Demonstrating Outcome Study in Kyoto] Registry Cohort-2, RESET [Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial], and NEXT [NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial]), we compared risks for ischemic and bleeding events from 13 to 36 months after percutaneous coronary intervention among patients with a DAPT score ≥2 (high DS) and a DAPT score <2 (low DS).Results: Among 12 223 patients receiving drug-eluting stents who were free from ischemic or bleeding events at 13 months after percutaneous coronary intervention, 3944 patients had high DS and 8279 had 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), whereas 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), whereas the cumulative incidences of noncardiac 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. [ABSTRACT FROM AUTHOR]

The article offers update from the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) on dual antiplatelet therapy in coronary artery disease. Topics discussed are efficacy and safety of dual antiplatelet therapy and risk stratification tools, dual antiplatelet therapy after percutaneous coronary intervention and dual antiplatelet therapy for patients treated with coronary artery bypass and those with medically managed acute coronary syndrome.

Antithrombotic therapy is represented by anticoagulation and antiplatelet therapy, and their combination. Currently, vitamin K antagonists, direct and indirect thrombin and factor Xa inhibitors including novel anticoagulants are available for anticoagulation therapy and acetylsalicylic acid or dual antiplatelet therapy with irreversible or reversible thrombocyte ADP receptor blockers for antiaggregation therapy. New version of the 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease was presented at the European Cardiologic Society conference 2017 in Barcelona. Addition of ticagrelor to routine therapy with acetylsalicylic acid is recommended in patients with acute coronary syndrome, regardless of initial therapeutic strategy. In patients with acute coronary syndrome undergoing coronary angioplasty, addition of prasugrel to acetylsalicylic acid is recommended as well as in patients with non‑STEMI, if they were not given another P2Y12 inhibitor yet, or in patients with STEMI treated with catheterization. Pre‑treatment with P2Y12 inhibitor is generally recommended only in patients with known coronary anatomy after the decision for coronary intervention as well as in patients with STEMI. Clopidogrel should be added to acetylsalicylic acid in patients with stable ischaemic heart disease undergoing stent implantation as well as in patients with acute coronary syndrome that cannot receive ticagrelor or prasugrel, including patients with prior intracranial bleeding or patients with an indication for oral anticoagulant therapy. Two scores are recommended to evaluate the duration of dual antiaggregation therapy: PRECISE‑DAPT SCORE a DAPT SCORE. [ABSTRACT FROM AUTHOR]

The use of aspirin and a P2Y12 receptor antagonist as dual antiplatelet therapy (DAPT) has become the treatment of choice in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention to prevent recurrent thrombotic events. Although DAPT is beneficial for most patients, few patients still experience recurrent thrombotic events and increased bleeding episodes. This article reviews current literature to identify various approaches that may enhance the DAPT benefit-risk ratio in patients with ACS. Three strategies addressed in this article include the following-(1) use of more potent antiplatelet agents other than clopidogrel; (2) addition of direct oral anticoagulants (DOACs) to DAPT; and (3) optimizing DAPT duration. Although the use of prasugrel or ticagrelor improves treatment efficacy, their use has been associated with increased risk of bleeding compared to clopidogrel. The combination of DOACs and DAPT may not be the most viable strategy because of its limited cardiovascular benefits and increased bleeding risks. The optimal duration of DAPT duration remains controversial. Most guidelines recommend 6 to 12 months of DAPT, whereas emerging studies have shown benefit for both shorter and longer duration of treatment. Risk stratification tools such as the DAPT score may play a role in individualizing DAPT duration according to patient's ischemic and bleeding risks. [ABSTRACT FROM AUTHOR]

Aim: The dual-antiplatelet therapy (DAPT) score is recommended for predicting the risk of ischemia and bleeding for patients undergoing percutaneous coronary intervention (PCI). This study aimed to investigate the long-term prognostic value of the DAPT score in older PCI patients., Methods: This study enrolled 10,724 consecutive patients who underwent PCI from January 2013 to December 2013 in Fu Wai hospital, among whom 2,981 (27.8%) were aged ≥ 65 years. The ischemic endpoint was major adverse cardiovascular and cerebrovascular events (MACCE, including myocardial infarction, all-cause death, and stroke). The bleeding endpoint was Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding., Results: After a 5-year follow-up, 256 (12.0%) MACCEs and 53 (2.5%) BARC 2, 3, or 5 bleeding occurred. The patients were divided into two groups according to the DAPT score: the low-score (＜2, n=1,646) and high-score (≥ 2, n=485) group. Multivariate Cox regression revealed that the risk of MACCE was similar between the two groups [hazard ratio (HR): 1.214, 95% confidence interval (CI): 0.916-1.609, P=0.178], whereas the risk of bleeding was significantly higher in the high-score group than in the low-score group (HR: 2.447, 95% CI: 1.407-4.257, P=0.002). The DAPT score did not show prognostic value in MACCE [area under the receiver operating characteristic curve (AUROC), 0.534; 95% CI: 0.496-0.572, P=0.079]; however, it demonstrated a certain prognostic value in BARC 2, 3, or 5 bleeding (AUROC, 0.646; 95% CI: 0.573-0.719, P＜0.001)., Conclusion: This study suggested that in older PCI patients, the DAPT score did not show predictive value for MACCE; however, it had a certain predictive value for 5-year BARC 2, 3, or 5 bleeding.

Background: Dual antiplatelet therapy (DAPT) score is used to stratify ischemic and bleeding risk for antiplatelet therapy after percutaneous coronary intervention (PCI). This study assessed the association between the DAPT score and clinical outcomes in acute coronary syndrome (ACS) patients who were treated with P2Y12 inhibitor monotherapy., Methods: A total of 498 ACS patients, with early aspirin discontinuation for various reasons and who received P2Y12 inhibitor monotherapy after PCI, were enrolled during the period from January 1, 2014 to December 31, 2018. The efficacy and safety between those with low (<2) and high (≥2) DAPT scores were compared during a 12-month follow-up after PCI. Inverse probability of treatment weighting was used to balance the covariates between the two groups. The primary endpoint was a composite outcome of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months. The safety endpoint was major bleeding, defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding., Results: The primary composite endpoint occurred in 11.56 and 14.38% of the low and high DAPT score groups, respectively. Although there was no significant difference in the primary composite endpoint between the two groups in the multivariate Cox proportional hazards models, the risk of recurrent ACS or unplanned revascularization was significantly higher in the high DAPT score group (adjusted hazard ratio [HR]: 1.900, 95% confidence interval [CI]: 1.095-3.295). The safety outcome for BARC 3 or 5 bleeding was similar between the two groups., Conclusions: Our results indicate that ACS patients receiving P2Y12 monotherapy with high DAPT score had an increased risk of recurrent ACS or unplanned revascularization., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Huang, Chen, Feng, Hsieh, Ho, Cheng, Yeh, Chen, Huang, Fang, Lin, Lin, Tsai, Su and Li.)

Aims: The dual antiplatelet therapy (DAPT) score is meant to aid clinicians choose the DAPT duration but attempts to examine the external validity of the DAPT score and its decision tool have reported mostly disappointing results. Our aim was to perform a meta-analysis of all available data on the external validity of the DAPT score., Methods and Results: We conducted a meta-analysis of studies that examined the external validity of the DAPT score/its decision tool. Seven studies (77 274 patients) were included. Follow-up ranged from 6 to 24 (median 18) months. Overall, high (≥2) DAPT score was associated with increased risk for myocardial infarction (MI)/stent thrombosis (ST) [odds ratio (OR) 1.54, 95% confidence interval (CI) 1.41-1.69; P < 0.01], and lower risk for bleeding (OR 0.84, 95% CI 0.73-0.97; P = 0.01). In the high DAPT score stratum, extended (12-24 months), as compared to standard (6-12 months) DAPT duration was associated with a reduction in the risk for MI/ST (OR 0.67, 95% CI 0.48-0.94; P = 0.02), and no difference in the risk for bleeding (OR 1.04, 95% CI 0.65-1.66; P = 0.88), while in the low DAPT score stratum, extended DAPT duration was associated with no difference in the risk for MI/ST (OR 1.04, 95% CI 0.76-1.43; P = 0.80), and an increased risk for bleeding (OR 1.58, 95% CI 1.15-2.15; P < 0.01)., Conclusions: This first meta-analysis of studies examining the external validation of the DAPT score and its decision tool, our results suggest that the DAPT score is useful both for stratifying post-percutaneous coronary intervention patients into risk strata for future ischaemic and bleeding events as well aiding in choosing the optimal DAPT duration for the individual patient., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Background: The dual antiplatelet therapy (DAPT) score was developed to estimate ischemic and bleeding risks from the DAPT study. However, few studies validated its utility externally. We sought to validate the utility of the DAPT score in the Japanese population., Methods: In a pooled cohort of 3 studies conducted in Japan (the CREDO-Kyoto [Coronary Revascularization Demonstrating Outcome Study in Kyoto] Registry Cohort-2, RESET [Randomized Evaluation of Sirolimus-Eluting Versus Everolimus-Eluting Stent Trial], and NEXT [NOBORI Biolimus-Eluting Versus XIENCE/PROMUS Everolimus-Eluting Stent Trial]), we compared risks for ischemic and bleeding events from 13 to 36 months after percutaneous coronary intervention among patients with a DAPT score ≥2 (high DS) and a DAPT score <2 (low DS)., Results: Among 12 223 patients receiving drug-eluting stents who were free from ischemic or bleeding events at 13 months after percutaneous coronary intervention, 3944 patients had high DS and 8279 had 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), whereas 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), whereas the cumulative incidences of noncardiac 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., (© 2017 American Heart Association, Inc.)

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.