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Akyuz S, Calik AN, Onuk T, Yaylak B, Kolak Z, Eren S, Mollaalioglu F, Durak F, Cetin M, Tanboga IH. The predictive value of PRECISE-DAPT score for long-term mortality in patients with acute coronary syndrome complicated by cardiogenic shock. Herz 2024; 49:302-308. [PMID: 38172314 DOI: 10.1007/s00059-023-05231-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 10/25/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Besides its primary clinical utility in predicting bleeding risk in patients with acute coronary syndrome (ACS), the PRECISE-DAPT (Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Anti-Platelet Therapy) score may also be useful for predicting long-term mortality in ACS patients presenting with cardiogenic shock (CS) since several studies have reported an association between the score and certain cardiovascular conditions or events. The aim of the present study was to evaluate the utility of the PRECISE-DAPT score for predicting the long-term all-cause mortality in patients (n = 293) with ACS presenting with CS. METHODS The PRECISE-DAPT score was calculated for each patient who survived in hospital, and the association with long-term mortality was studied. Median follow-up time was 2.7 years. The performance of the final model was determined with measurements of its discriminative power (Harrell's and Uno's C indices and time-dependent area under the receiver operating characteristic curve [AUC]) and predictive accuracy (coefficient of determination [R2] and likelihood ratio χ2). Hazard ratios (HRs) were used to assess the relationship between the variables of the model and long-term all-cause death. RESULTS All-cause death occurred in 197 patients (67%). There was a positive association between the PRECISE-DAPT score (change from 17 to 38 was associated with an HR of 2.42 [95% CI: 1.59-3.68], R2 = 0.209, time-dependent AUC = 0.69) and the risk of death such that in the adjusted survival curve, the risk of mortality increased as the PRECISE-DAPT score increased. CONCLUSION The PRECISE-DAPT score may be a useful easy-to-use tool for predicting long-term mortality in patients with ACS complicated by CS.
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Affiliation(s)
- Sukru Akyuz
- Department of Cardiology, Faculty of Medicine, Okan University, Acibadem Mahallesi, Elysium Elit Kosuyolu A Blok D.1, Kadikoy, Istanbul, Turkey.
| | - Ali Nazmi Calik
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Baris Yaylak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zeynep Kolak
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Feyza Mollaalioglu
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Furkan Durak
- Department of Cardiology, Ilhan Varank Sancaktepe Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Cetin
- Department of Cardiology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - Ibrahim Halil Tanboga
- Department of Biostatistics, Nisantasi University Medical School, Istanbul, Turkey
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, Turkey
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Polat F, Yaylak B, Onuk T, Çalık AN, Akyüz Ş, Dayı ŞÜ. Predictive value of PRECISE-DAPT score for long-term all-cause mortality in atrial fibrillation patients with non-ST-elevation myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:217-224. [PMID: 37854965 PMCID: PMC10580842 DOI: 10.5114/aic.2023.131474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/19/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Atrial fibrillation (AF) may co-exist in patients with non-ST-elevation myocardial infarction (NSTEMI). In patients with NSTEMI, AF should therefore be regarded as an important risk factor irrespective of its presentation. To predict outcomes in AF patients presenting with NSTEMI, early risk stratification can help to identify the patients with a possible poor long-term prognosis. The development of the PRECISE-DAPT score aimed to predict the risk of bleeding in patients who underwent stent implantation and received dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI), providing a valuable tool for assessing bleeding risk in this specific patient population. Aim To assess the performance of the PRECISE-DAPT score in predicting long-term prognosis in AF patients with NSTEMI. Material and methods Five hundred and twenty-six consecutive AF patients presenting with NSTEMI were included in the present study. The PRECISE-DAPT score was calculated in each case and evaluated for the association of increased mortality in the study population, who survived in-hospital but died in the long term. Results All-cause mortality deaths occurred in 278 (52.6%) patients. Higher PRECISE-DAPT score, shorter duration of P2Y12 inhibitor therapy, decreased left ventricular ejection fraction (LVEF), and a history of diabetes mellitus (DM) were all associated with an increased risk of all-cause mortality in the multivariable logistic regression model. Conclusions High PRECISE-DAPT score was associated with higher long-term all-cause mortality in AF patients presenting with NSTEMI.
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Affiliation(s)
- Fuat Polat
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Barış Yaylak
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Tolga Onuk
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Nazmi Çalık
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Şükrü Akyüz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Risk Stratification of Patients with Acute Coronary Syndrome. J Clin Med 2021; 10:jcm10194574. [PMID: 34640592 PMCID: PMC8509298 DOI: 10.3390/jcm10194574] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/17/2022] Open
Abstract
Defining the risk factors affecting the prognosis of patients with acute coronary syndrome (ACS) has been a challenge. Many individual biomarkers and risk scores that predict outcomes during different periods following ACS have been proposed. This review evaluates known outcome predictors supported by clinical data in light of the development of new treatment strategies for ACS patients during the last three decades.
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Bayam E, Öztürkeri B, Yıldırım E, Kalçık M, Küp A, Çakmak EÖ, Günay N, Güner A, Kalkan S, Karaduman A, Kahyaoğlu M, Zehir R. The relationship between dual antiplatelet treatment (DAPT) score and saphenous venous grafts patency after coronary artery bypass grafting surgery. Acta Cardiol 2021; 76:785-791. [PMID: 33880976 DOI: 10.1080/00015385.2021.1912248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) remains the gold standard treatment for mutivessel and left main coronary artery disease (CAD). Saphenous vein graft (SVG) patency is still a problem in CAD patients after CABG surgery. The Dual Antiplatelet Treatment (DAPT) score is a clinical prediction tool that predicts ischaemic and bleeding risk in CAD patients. The aim of this study is to investigate the relationship between DAPT score and SVG patency in CABG patients. METHOD This retrospective study enrolled a total of 398 patients (68 female; mean age 65.8 ± 9.1 years) with a history of CABG surgery. The study population was divided into two subgroups according to SVG patency. The DAPT score was calculated for each patients and compared between the two groups. RESULTS Coronary angiography revealed SVG disease in 212 patients and SVG patency in 186 patients. The rates of diabetes mellitus and hypertension, red cell distribution width values, DAPT Score, time interval after CABG and number of SVGs were significantly higher while LVEF was significantly lower in patients with SVG disease. The presence of diabetes mellitus, high DAPT score, long time interval after CABG and high number of SVGs were found to be independent predictors of SVG patency. DAPT score above 2.5 predicted SVG disease with a sensitivity of 77.1% and a specificity of 87.1% (AUC: 0.873; 95%CI: 0.823-0.924; p < 0.001). CONCLUSION The DAPT score may provide useful information for SVG patency in CABG patients. Patients with high DAPT score should be followed up closely for SGV occlusion. DAPT score may be useful prior to CABG in determining the duration of dual anti-platelet therapy and in encouraging the use of arterial grafts with better patency.
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Affiliation(s)
- Emrah Bayam
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Burak Öztürkeri
- Depertament of Cardiology, Umraniye Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Ersin Yıldırım
- Depertament of Cardiology, Umraniye Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Macit Kalçık
- Depertament of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Ayhan Küp
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Ender Özgün Çakmak
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Nuran Günay
- Depertament of Cardiology, Umraniye Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Semih Kalkan
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | - Ahmet Karaduman
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
| | | | - Regayip Zehir
- Depertament of Cardiology, Kartal Kosuyolu High Specialty Training and Research Hospital, University of Medical Sciences, İstanbul, Turkey
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Wang N, Liang C. Relationship of Gensini score with retinal vessel diameter and arteriovenous ratio in senile CHD. Open Life Sci 2021; 16:737-745. [PMID: 34316514 PMCID: PMC8285989 DOI: 10.1515/biol-2021-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background This study aimed to find the correlation of Gensini score with retinal vessel diameter and arteriovenous ratio in elderly patients with coronary heart disease (CHD). Methods This study included 120 senile CHD patients as the CHD group and 100 healthy individuals as the normal group (NG). Gensini score was used to evaluate the severity of coronary artery lesions. Central retinal artery equivalents (CRAE), central retinal venular equivalents (CRVE), and arteriovenous ratio (AVR) were measured. Results CHD group has lower CRAE and AVR than NG, while higher CRVE was observed in NG. CRAE and AVR in UAP (unstable angina pectoris) and AMI (acute myocardial infarction) groups showed reduction (stable angina pectoris); however, enhanced CRVE and Gensini scores in UA and AMI groups were observed as compared to the SAP group. CRAE and AVR in moderate and severe groups were reduced to a greater extent compared to the mild groups, while enhanced CRVE and Gensini scores were observed more often in the severe group than the mild group. CRAE and AVR were negatively correlated with the Gensini score; however, CRVE was positively correlated with the Gensini score. Conclusion AVR is expected to be a noninvasive index to diagnose and predict senile CHD, which has a certain evaluation value. Diabetes, smoking history, and TC are independent risk factors of senile CHD.
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Affiliation(s)
- Ning Wang
- Department of Cardiovascularology, Jinan Seventh People’s Hospital, Jinan 250132, Shandong Province, China
| | - Changsen Liang
- Department of Ophthalmology, Jinan Seventh People’s Hospital, 21th Gongye North Road, Licheng District, Jinan 250132, Shandong Province, China
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Şaylık F, Akbulut T. The association of PRECISE-DAPT score with thrombus burden in patients with ST-segment elevation myocardial infarction. Acta Cardiol 2021; 77:449-455. [PMID: 34309488 DOI: 10.1080/00015385.2021.1954747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The presence of intracoronary thrombus is associated with adverse events in patients with ST-segment elevation myocardial infarction (STEMI). PRECISE-DAPT score is used to detect the bleeding risk in STEMI patients who are on dual antiplatelet therapy. Recently, the PRECISE-DAPT score was shown to be related to cardiovascular events. We aimed to investigate the association of PRECISE-DAPT score with thrombus burden in patients with STEMI. METHODS A retrospective analysis with 204 STEMI patients undergoing primary percutaneous coronary intervention was conducted in this study. Thrombus burden grade and PRECISE-DAPT score were calculated for each subject. Patients were divided into two groups as high thrombus burden (HTB) (grade 4, 5) and low thrombus burden (LTB) (grade 1, 2 and 3) based on thrombus burden grade. The PRECISE-DAPT scores were compared between thrombus burden groups. RESULTS The mean age in HTB (N = 136) was 63.7 (11.3), and 64.7% were male. HTB had a higher PRECISE-DAPT score than LTB (p < .0001). PRECISE-DAPT score, baseline troponin I levels, ejection fraction, and pain to balloon time were independent predictors of HTB. CONCLUSIONS PRECISE-DAPT score was an independent predictor of HTB in patients with STEMI.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Health Science University, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Research Hospital, Health Science University, Van, Turkey
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Selçuk M, Çınar T, Şaylık F, Demiroz Ö, Yıldırım E. The Association of a PRECISE-DAPT Score With No-Reflow in Patients With ST-Segment Elevation Myocardial Infarction. Angiology 2021; 73:68-72. [PMID: 33878953 DOI: 10.1177/00033197211010602] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to evaluate the association of admission PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti Platelet Therapy (PRECISE-DAPT) score with the development of no-reflow (NR) in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). In this observational, retrospective study, 335 consecutive STEMI patients who were treated with primary PCI were included. We classified the study population into 2 groups: patients with a PRECISE-DAPT score <25 and those with a PRECISE-DAPT score ≥25. Overall, 30 (8.9%) patients developed NR. The mean PRECISE-DAPT score (20.03 ± 15.32 vs 11.33 ± 12.18; P = .005) was significantly higher in cases who developed NR. Moreover, arrhythmic complications, in-hospital shock, and in-hospital mortality rates were significantly higher in patients with a PRECISE-DAPT score ≥25 compared to those with a PRECISE-DAPT score <25. According to a multivariable analysis, the PRECISE-DAPT score was found to be independently linked with NR (odds ratio: 2.87, with P = .015). To our knowledge, these data are the first in major medical science databases to determine the relationship between the PRECISE-DAPT score and the NR phenomenon in patients with STEMI undergoing primary PCI.
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Affiliation(s)
- Murat Selçuk
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Sultan II. Abdülhamid Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Faysal Şaylık
- Department of Cardiology, Van Training and Research Hospital, Van, Turkey
| | - Önder Demiroz
- Department of Cardiology, Ümraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Ersin Yıldırım
- Department of Cardiology, Ümraniye Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Dannenberg L, Afzal S, Czychy N, M'Pembele R, Zako S, Helten C, Mourikis P, Zikeli D, Ahlbrecht S, Trojovsky K, Benkhoff M, Barcik M, Wolff G, Zeus T, Kelm M, Polzin A. Risk prediction of bleeding and MACCE by PRECISE-DAPT score post-PCI. IJC HEART & VASCULATURE 2021; 33:100750. [PMID: 33763519 PMCID: PMC7973296 DOI: 10.1016/j.ijcha.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/06/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Background Guidelines recommend the PRECISE-DAPT (PD) score to adapt duration of dual antiplatelet therapy due to bleeding risk. However, there is first evidence that PD predicts mortality and ischemic events as well. Methods We investigated PD Score in 994 patients after percutaneous coronary intervention (PCI). PD was correlated with clinically frequently used scores. Major adverse cardiac and cerebrovascular events (MACCE) and Thrombolysis in Myocardial Infarction (TIMI) bleeding were assessed during one-year follow-up. Results 524 patients had PD < 25 and 470 patients PD ≥ 25 (47%). Rate of major and minor bleeding was higher in the PD ≥ 25 group (major bleeding: Hazard ratio [HR] 2.9, 95% confidence interval [Cl] 1.01–8.16, p = 0.049; minor bleeding: HR 3.94, 95% Cl 1.36–9.19, p = 0.0096). Rate of MACCE, death and myocardial infarction were higher as well (MACCE: HR 2.0, 95% Cl 1.52–2.71, p < 0.0001; death: HR 3.9, 95% Cl 2.12–5.68, p < 0.0001; MI: HR 2.1, 95% Cl 1.26–3.43, p = 0.0041). Rate of stroke/transient ischemic attack did not differ between groups. Discriminative potency to predict major and minor bleeding, MACCE, death and MI were high with nearly equal cut-off values calculated by Youden’s index (YI) (major bleeding: Area under the curve [AUC] 0.66; p = 0.026; YI 32; minor bleeding: AUC 0.72; p = 0.001; YI 28; MACCE: AUC 0.62; p < 0.0001; YI 24). Conclusion In our cohort, PD score predicted bleeding moderately in post-PCI patients. In this study, ischemic events were predicted as well. Adaption of antiplatelet therapy duration by PD score is accurate. Nevertheless, it should be well-balanced with patient-related risk for ischemic events.
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Key Words
- AF, Atrial fibrillation
- Bleeding
- DAPT
- DAPT, Dual antiplatelet medication
- GRACE, Global Registry of Acute Coronary Events
- MACCE
- MACCE, Major adverse cardiac and cerebrovascular events
- PARIS, Patterns of Non-Adherence to Anti-Platelet Regimen in Stented Patients
- PCI, percutaneous coronary intervention
- PD, PRECISE-DAPT, PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy
- ROC, Receiver operating characteristic
- STEMI, ST-elevation myocardial infarction
- Scores
- TIA, Transient ischemic attack
- TIMI
- TIMI, Thrombolysis in myocardial infarction
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Affiliation(s)
- Lisa Dannenberg
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Shazia Afzal
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Natalia Czychy
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, University Hospital Duesseldorf, Germany
| | - Saif Zako
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Carolin Helten
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Philipp Mourikis
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Dorothee Zikeli
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Samantha Ahlbrecht
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Kajetan Trojovsky
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Marcel Benkhoff
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Maike Barcik
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Georg Wolff
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Tobias Zeus
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Malte Kelm
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Amin Polzin
- Cardiovascular Research Institute Düsseldorf (CARID), Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Medical Faculty, Duesseldorf, Germany
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Kwok CS, Wong CW, Nagaraja V, Mamas MA. A systematic review of the studies that evaluate the performance of the DAPT score. Int J Clin Pract 2020; 74:e13591. [PMID: 32562449 DOI: 10.1111/ijcp.13591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Chun Shing Kwok
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chun Wai Wong
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Vinayak Nagaraja
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
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Elzanaty AM, Nazir S, Awad MT, Elsheikh E, Ahuja KR, Donato A, Eltahawy EA. Meta-Analysis of the Efficacy and Safety of P2Y 12 Inhibitor Monotherapy After Short Course of Dual-Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1500-1506. [PMID: 32457020 DOI: 10.1016/j.carrev.2020.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/29/2020] [Accepted: 05/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Guidelines recommend dual antiplatelet therapy (DAPT) following drug-eluting stent (DES) placement for ≥12 months in acute coronary syndrome or 6 months in stable coronary artery disease. However, with the advent of newer-generation stents, the optimal duration of DAPT to balance bleeding and thrombotic risks has been debated. OBJECTIVES We aimed to perform a meta-analysis of randomized controlled trials (RCT) comparing P2Y12 monotherapy in short-duration group (SDG) vs. standard treatment group (STG) course of DAPT in patients undergoing PCI. METHODS Electronic databases were searched for RCTs of patients undergoing percutaneous coronary intervention (PCI) with DES placement who received short (≤ 3 months) vs. standard DAPT course (≥12 months) and were followed for ≥12-months. Rates of major adverse cardiovascular events (a composite of cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke) were the primary outcome. Study-specific odds ratios (OR) and corresponding 95% confidence intervals were calculated using random-effects model. RESULTS A total of 20,706 patients (10,344 in the SDG and 10,362 in the STG) were analysed from four studies. There was no significant difference observed for MACE (OR = 0.95, 95% CI: 0.81-1.08, P = .92, I2 = 0%) myocardial infarction or stent thrombosis. However, lower rates of major bleeding were noted in the SDG (1.20 vs. 1.80%; OR: 0.61; 95% CI: 0.37-0.99; P = .04; I2 = 71%) albeit with increased heterogeneity. CONCLUSION A short duration of DAPT followed by P2Y12 inhibitor monotherapy was comparable to 12 months of DAPT with respect to MACE and thrombotic events, with lower rates of major bleeding events in select group of patients undergoing PCI. More data is needed to assess efficacy in patients with complex lesions and high risk ACS population including those with STEMI presentation.
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Affiliation(s)
- Ahmed M Elzanaty
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Salik Nazir
- Departement of Cardiology, University of Toledo Medical Center, Toledo, OH, USA
| | - Mohammed T Awad
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Eman Elsheikh
- Departement of Cardiology, Tanta University Hospital, Tanta, Egypt
| | - Keerat Rai Ahuja
- Departement of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Ehab A Eltahawy
- Departement of Cardiology, University of Toledo Medical Center, Toledo, OH, USA.
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Bi S, Zhao Y, Peng Q, Liu W, Zhang G, Zhang C. Contradictions between DAPT and PRECISE-DAPT scores with the severity of coronary lesion in acute coronary syndrome. Medicine (Baltimore) 2020; 99:e19699. [PMID: 32311950 PMCID: PMC7220694 DOI: 10.1097/md.0000000000019699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to identify the correlation of contradiction between DAPT score and PRECISE-DAPT score with the severity of coronary lesion in acute coronary syndromes (ACS).In total, 458 patients with ACS after a percutaneous coronary intervention (PCI) who had tolerated 1-year uneventful dual antiplatelet therapy (DAPT) were enrolled and divided into groups based on the Gensini score, number of stenosed vessels, and left main (LM) disease. Both DAPT score and PRECISE-DAPT score were calculated and the proportion of patients receiving conflicting recommendations from each score was compared among the groups.DAPT score as well as the proportion of patients with DAPT score ≥2 were associated with the Gensini score and the number of stenosed vessels. Similarly, PRECISE-DAPT score as well as the proportion of patients with PRECISE-DAPT score ≥25 were associated with the Gensini score and the number of stenosed vessels. The proportion of patients with DAPT score ≥2 along with PRECISE-DAPT score ≥25 were associated with Gensini score, but they had no significant association with the number of stenosed vessels (P = .006 and P = .075, respectively). None of those aforementioned items were associated with LM disease.The inconsistencies of DAPT scores and PRECISE-DAPT scores are frequent and associated with the severity of coronary disease, represented by the Gensini score. Appropriate clinical decisions should be individualized.
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Affiliation(s)
- Sisi Bi
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Yue Zhao
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University
| | - Qingling Peng
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Wenxue Liu
- Department of Cardiology, Xiangya Hospital of Central South University
| | - Guogang Zhang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Chenglong Zhang
- Department of Cardiology, Xiangya Hospital of Central South University
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12
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Saito Y, Kobayashi Y. Update on Antithrombotic Therapy after Percutaneous Coronary Intervention. Intern Med 2020; 59:311-321. [PMID: 31588089 PMCID: PMC7028427 DOI: 10.2169/internalmedicine.3685-19] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/26/2019] [Indexed: 02/06/2023] Open
Abstract
Percutaneous coronary intervention (PCI) has become a standard-of-care procedure in the setting of angina or acute coronary syndrome. Antithrombotic therapy is the cornerstone of pharmacological treatment aimed at preventing ischemic events following PCI. Dual antiplatelet therapy as the combination of aspirin and P2Y12 inhibitor has been proven to decrease stent-related thrombotic risks. However, the optimal duration of dual antiplatelet therapy, an appropriate P2Y12 inhibitor, and the choice of aspirin versus P2Y12 inhibitor as single antiplatelet therapy remain controversial. Furthermore, the combined use of oral anticoagulation in addition to antiplatelet therapy is a complex issue in clinical practice, such as in patients with atrial fibrillation. The key challenge concerning the optimal antithrombotic regimen is ensuring a balance between protection against thrombotic events and against excessive increases in bleeding risk. In this review article, we summarize the current evidence concerning antithrombotic therapy in patients with coronary artery disease undergoing PCI.
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Affiliation(s)
- Yuichi Saito
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
- Yale School of Medicine, USA
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Japan
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13
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The predictive value of PRECISE-DAPT score for arrhythmic complications in patients with ST-elevation myocardial infarction. Coron Artery Dis 2019; 30:499-504. [DOI: 10.1097/mca.0000000000000788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Morici N, Tavecchia GA, Antolini L, Caporale MR, Cantoni S, Bertuccio P, Sacco A, Meani P, Viola G, Brunelli D, Oliva F, Lombardi F, Segreto A, Oreglia JA, La Vecchia C, Cattaneo M, Valgimigli M, Savonitto S. Use of PRECISE-DAPT Score and Admission Platelet Count to Predict Mortality Risk in Patients With Acute Coronary Syndrome. Angiology 2019; 70:867-877. [PMID: 31088127 DOI: 10.1177/0003319719848547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Antiplatelet Therapy (PRECISE-DAPT) score has been validated to predict bleeding complications in patients undergoing stent implantation and dual antiplatelet therapy. This score does not include the platelet count (PC), which has been shown to be an independent marker of mortality in patients with acute coronary syndrome (ACS). We assessed the role of the PRECISE-DAPT score calculated on admission for mortality risk prediction and evaluated whether the predictive accuracy of this score improved by adding the PC. In a retrospective cohort study of 1000 patients with ACS, after adjustment for relevant covariates, a PRECISE-DAPT score ≥25 was independently associated with mortality (hazard ratio [HR]: 7.91; 95% confidence interval [CI]: 4.37-14.30). When this score was combined with PC, compared to patients with PRECISE-DAPT <25 and PC ≥150 × 109/L, the adjusted HR was 7.2 (95% CI 2.4-21.6) for those with PRECISE-DAPT <25 and PC <150 × 109/L; 10.7 (95% CI: 5.2-21.9) for those with PRECISE-DAPT ≥25 and PC ≥150 × 109/L; and 17.9 (95% CI 7.0-45.4) for those with PRECISE-DAPT ≥25 and PC <150 × 109/L. Selecting thresholds for high-risk designation, the PRECISE-DAPT score integrated with PC had a higher prediction value, compared to the PRECISE-DAPT and Global Registry of Acute Coronary Events scores.
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Affiliation(s)
- Nuccia Morici
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.,2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanni A Tavecchia
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Antolini
- 3 School of Medicine, Center of Biostatistics for Clinical Epidemiology, University of Milano Bicocca, Monza, Italy
| | - Maria R Caporale
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Silvia Cantoni
- 4 Hematology Department, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Bertuccio
- 2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Alice Sacco
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Meani
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giovanna Viola
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Dario Brunelli
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Oliva
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Federico Lombardi
- 5 UOC Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milano, Italy
| | - Antonio Segreto
- 6 Dipartimento di Emergenza e Trapianto d'Organo, Università di Bari, Bari, Italy
| | - Jacopo A Oreglia
- 1 Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Carlo La Vecchia
- 2 Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Marco Cattaneo
- 7 Health Science Department, Università Degli Studi di Milano, Milan, Italy.,8 Unità di Medicina 3, ASST Santi Paolo e Carlo, Milan, Italy
| | - Marco Valgimigli
- 9 Department of Cardiology, University Hospital of Bern, Bern, Switzerland
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