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PLoS One. 2019 Feb 14;14(2):e0209661. doi: 10.1371/journal.pone.0209661. eCollection 2019.

Development of a risk score for predicting the benefit versus harm of extending dual antiplatelet therapy beyond 6 months following percutaneous coronary intervention for stable coronary artery disease.

Author information

1
The Department of cardiology, Rabin Medical Center, Petah-Tikva, Israel.
2
The Sackler school of medicine, Tel-Aviv University, Tel-Aviv, Israel.
3
Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
4
Clalit Research Institute, Chief Physician's Office, Clalit health Services, Tel-Aviv, Israel.
5
Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheeva, Israel.
6
Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.

Abstract

BACKGROUND:

Decisions on dual antiplatelet therapy (DAPT) duration should balance the opposing risks of ischaemia and bleeding. Our aim was to develop a risk score to identify stable coronary artery disease (SCAD) patients undergoing PCI who would benefit or suffer from extending DAPT beyond 6 months.

METHODS:

Retrospective analysis of a cohort of patients who completed 6 months of DAPT following PCI. Predictors of ischaemic and bleeding events for the 6-12 month period post-PCI were identified and a risk score was developed to estimate the likelihood of benefiting from extending DAPT beyond 6 months. Incidence of mortality, ischaemic and bleeding events for patients treated with DAPT for 6 vs. 6-12 months, was compared, stratified by strata of the risk score.

RESULTS:

The study included 2,699 patients. Over 6 months' follow up, there were 78 (2.9%) ischaemic and 43 (1.6%) bleeding events. Four variables (heart failure, left ventricular ejection fraction ≤30%, left main or three vessel CAD, status post (s/p) PCI and s/p stroke) predicted ischemic events, two variables (age>75, haemoglobin <10 g/dL) predicted bleeding. In the lower stratum of the risk score, 6-12 months of treatment with DAPT resulted in increased bleeding (p = 0.045) with no decrease in ischaemic events. In the upper stratum, 6-12 months DAPT was associated with reduced ischaemic events (p = 0.029), with no increase in bleeding.

CONCLUSION:

In a population of SCAD patients who completed 6 months of DAPT, a risk score for subsequent ischaemic and bleeding events identified patients likely to benefit from continuing or stopping DAPT.

PMID:
30763340
PMCID:
PMC6375573
DOI:
10.1371/journal.pone.0209661
[Indexed for MEDLINE]
Free PMC Article

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