Author + information
- Received September 26, 2019
- Revision received December 1, 2019
- Accepted December 11, 2019
- Published online March 2, 2020.
- Ply Chichareon, MDa,b,∗,
- Rodrigo Modolo, MDa,c,∗,
- Hideyuki Kawashima, MDa,
- Kuniaki Takahashi, MDa,
- Norihiro Kogame, MDa,
- Chun-Chin Chang, MDd,
- Mariusz Tomaniak, MDd,e,
- Masafumi Ono, MDa,
- Simon Walsh, MDf,
- Harry Suryapranata, MD, PhDg,
- James Cotton, MDh,
- Rene Koning, MDi,
- Ibrahim Akin, MDj,
- Neville Kukreja, MD, PhDk,
- Joanna Wykrzykowska, MD, PhDa,
- Jan J. Piek, MD, PhDa,
- Scot Garg, MD, PhDl,
- Christian Hamm, MDm,
- Philippe Gabriel Steg, MDn,o,
- Peter Jüni, MDp,
- Pascal Vranckx, MD, PhDq,
- Marco Valgimigli, MD, PhDr,
- Stephan Windecker, MDr,
- Yoshinobu Onuma, MD, PhDs and
- Patrick W. Serruys, MD, PhDs,t,∗ ()
- aDepartment of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- bCardiology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- cDepartment of Internal Medicine, Cardiology Division, University of Campinas, Campinas, Brazil
- dDepartment of Interventional Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands
- eFirst Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
- fDepartment of Cardiology, Belfast Health and Social Care Trust, Belfast, United Kingdom
- gDepartment of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
- hDepartment of Cardiology, Heart and Lung Centre, New Cross Hospital, Wolverhampton, United Kingdom
- iCardiology Service, Clinique Saint-Hilaire, Rouen, France
- jFirst 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
- kDepartment of Cardiology, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
- lDepartment of Cardiology, East Lancashire Hospitals NHS Trust, Blackburn, Lancashire, United Kingdom
- mKerckhoff Heart Center, University of Giessen, Bad Nauheim, Germany
- nFrench Alliance for Cardiovascular Trials, INSERM U-1148, Hôpital Bichat, Université Paris-Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
- oImperial College and the Institute of Cardiovascular Medicine and Science, National Heart and Lung Institute, Royal Brompton Hospital, London, United Kingdom
- pApplied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- qDepartment of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- rDepartment of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- sDepartment of Cardiology, National University of Ireland, Galway, Galway, Ireland
- tInternational Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Patrick W. Serruys, Department of Cardiology, National University of Ireland Galway, University Road, Galway, H91 TK33, Ireland.
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.
- dual-antiplatelet therapy score
- myocardial infarction
- percutaneous coronary intervention
- risk stratification
↵∗ Drs. Chichareon and Modolo contributed equally to this paper.
The GLOBAL LEADERS study was sponsored by the European Clinical Research Institute, which received funding from AstraZeneca, Biosensors International and The Medicines Company. The study funders had no role in trial design, data collection, analysis, interpretation of the data, preparation, approval or making decision to submit the manuscript or publication. Dr. Chichareon has received grant support from Biosensors international outside the submitted work. Dr. Modolo has received grant support from Biosensors International and SMT, outside the submitted work. Dr. Tomaniak has received lecture fees from AstraZeneca, outside the submitted work. Dr. Kukreja has received grants from Dalcor Pharma, the Population Health Research Institute, the European Cardiovascular Research Institute, and Daiichi-Sankyo; and has received personal fees from AstraZeneca and Pfizer, outside the submitted work. Dr. Piek has received nonfinancial support from Abbott Vascular; and has received personal fees and nonfinancial support from Philips/Volcano, outside the submitted work. Dr. Hamm has received personal fees from and served on the advisory board for AstraZeneca. Dr. Steg has received grant support from Bayer/Janssen, Merck, Sanofi, and Amarin; and has received speaking or consulting fees from Amarin, Amgen, Bristol-Myers Squibb, Bayer/Janssen Boehringer Ingelheim, Pfizer, Idorsia, Novartis, Novo Nordisk, Regeneron, Lilly, AstraZeneca, Sanofi, and Servier, outside the submitted work. Dr. Jüni has received grant support from the Canadian Institutes of Health Research, AstraZeneca, Biotronik, Biosensors International, Eli Lilly, and The Medicines Company, outside the submitted work; has received institutional honoraria for serving on the advisory board for Amgen; and has served as unpaid member of the steering group of trials funded by AstraZeneca, Biotronik, Biosensors, St. Jude Medical, and The Medicines Company. Dr. Vranckx has received personal fees from AstraZeneca, The Medicines Company, Daiichi-Sankyo, Bayer AG, CLS Behring, and Terumo, outside the submitted work. Dr. Valgimigli has received grant support from Abbott, Terumo, Medicure, and AstraZeneca; and has received personal fees from Abbott, Chiesi, Bayer, Daiichi-Sankyo, Amgen, Terumo, Alvimedica, AstraZeneca, Biosensors, and Idorsia, outside the submitted work. Dr. Windecker has received institutional research and educational grants from Amgen, Abbott, Bristol-Myers Squibb, Bayer, CSL Behring, Boston Scientific, Biotronik, Edwards Lifesciences, Medtronic, Polares, Terumo, St. Jude Medical, and Sinomed. Dr. Onuma has served on the advisory board for Abbott Vascular. Dr. Serruys has received personal fees from Abbott Laboratories, AstraZeneca, Biotronik, Cardialysis, GLG Research, Medtronic, Sino Medical Sciences Technology, Europa Digital Publishing, Stentys France, Svelte Medical Systems, Philips/Volcano, St. Jude Medical, Qualimed, and Xeltis, outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 26, 2019.
- Revision received December 1, 2019.
- Accepted December 11, 2019.
- 2020 American College of Cardiology Foundation
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