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Value of Prolonged DAPT Varies With DAPT Score in PCI Patients

WEDNESDAY, June 14, 2017 -- For patients undergoing percutaneous coronary intervention (PCI), prolonged dual-antiplatelet therapy (DAPT) results in harm for those with low DAPT scores but reduces risk for ischemic events for those with high scores receiving paclitaxel-eluting stents, according to a study published online June 13 in the Annals of Internal Medicine.

Raffaele Piccolo, M.D., from Bern University Hospital in Switzerland, and colleagues examined the safety and efficacy of DAPT duration according to DAPT score in a randomized clinical trial. A total of 1,970 patients undergoing PCI were randomized to receive DAPT (aspirin and clopidogrel) for 24 versus six months.

The researchers found that 44.9 and 55.1 percent of patients had a DAPT score of at least 2 and a score of less than 2, respectively. Patients with high scores had a greater reduction in the primary efficacy outcome with 24- versus six-month DAPT (risk difference for score ≥2, −2.05 percentage points; risk difference for score <2, 2.91 percentage points; P = 0.030). For primary efficacy outcome, the difference by score varied by stent type; prolonged DAPT with high scores was only effective for patients with paclitaxel-eluting stents (risk difference, −7.55 percentage points). Patients with low scores had a greater increase in the primary safety outcome with 24- versus six-month DAPT (risk difference for score ≥2, 0.20 percentage points; risk difference for score <2, 2.58 percentage points; P = 0.046).

"Whether prolonged DAPT benefits patients with high scores treated with contemporary drug-eluting stents requires further study," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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Posted: June 2017