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Utility of the dual antiplatelet therapy score to guide antiplatelet therapy: A systematic review and meta‐analysis
Author(s) -
Mihatov Nino,
Secemsky Eric A.,
Kereiakes Dean J.,
Steg Gabriel,
Serruys Patrick W.,
Chichareon Ply,
Shen Changyu,
Yeh Robert W.
Publication year - 2021
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.29352
Subject(s) - medicine , percutaneous coronary intervention , randomized controlled trial , meta analysis , relative risk , framingham risk score , cardiology , myocardial infarction , confidence interval , disease
Background The dual antiplatelet therapy (DAPT) score, one of the first prediction tools to attempt to uncouple bleeding and ischemic risk following percutaneous coronary intervention, can help guide antiplatelet duration after coronary intervention. Evaluating the generalizability of the score is important to understand its utility in clinical practice. Methods We conducted a systematic review and meta‐analysis of studies that validated the DAPT score. A random effect meta‐analysis was performed of ischemic and bleeding risk based on DAPT score. A secondary analysis assessed the risk of longer versus shorter P2Y 12 inhibitor duration on ischemic and bleeding risk in randomized controlled trials of DAPT duration. Results We identified 10 patient cohorts involving 88,563 patients. Compared with a low DAPT score, a high DAPT score was associated with increased ischemic risk (RR: 1.62, 95% CI: 1.41–1.87) and reduced bleeding risk (RR: 0.80, 95% CI: 0.70–0.92). In three randomized trials of DAPT duration that contained information on the DAPT score, the relative risk of net adverse clinical events (combined ischemic and bleeding events) with longer duration of DAPT was 1.56 (95% CI: 0.77–3.19) for low DAPT score patients, and 0.86 (95% CI: 0.61–1.21) for high DAPT score patients ( p interaction = .14). Conclusions In this large meta‐analysis, the DAPT score consistently stratified bleeding and ischemic risk in opposing directions across several different study populations. More evaluation is needed to understand if the effect of longer DAPT duration on NACE is modified by the DAPT score in current practice.