所属 医学部 医学科（東京女子医科大学病院） 職種 助教
|発表タイトル||Dapt Score Does Not Predict Clinical Outcomes in Hemodialysis Patients on Prolonged Dual Antiplatelet Therapy After Coronary Intervention|
|会議名||AHA 2016 (American Heart Associations Scientific Sessions 2016)|
|主催者||American Heart Associations|
|発表者・共同発表者||◎TANAKA Kazuki, JUJO Kentaro, OOTSUKI Hisao, SHIMAZAKI Kensuke, NAKAO Masashi, ARASHI Hiroyuki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa|
|New Orleans, USA|
Introduction: Recent studies have shown that DAPT score with cut-off value of 2-point had clinical benefits in predicting embolic and bleeding events after percutaneous coronary intervention (PCI). However to date, there has been little report testing the efficacy of DAPT score on clinical outcomes of hemodialysis patients as a population at the highest risk.
Methods: This study included 239 consecutive patients on regular hemodialysis who received thienopyridine and aspirin for at least 12 months after PCI. DAPT score in the study population was graded from -2 to 10 points at the time of PCI. During a median follow-up period of 730 days, the rate of cardiovascular (CV) death, major adverse cardiac events (MACE) including CV death, target vascular revascularization and non-fatal myocardial infarction (MI), and major bleeding were compared between patients with high-DAPT score (score ≥2, n=146) and low-DAPT score (score <2, n=93).
Results: High-DAPT group included younger diabetic patients with impaired left ventricular ejection fraction, compared to low-DAPT group. However, patients who had history of MI or PCI, and patients presenting with MI were similarly prevalent (6.7% vs. 5.0%, p=0.90) in both groups. Kaplan-Meier analysis revealed that any adverse event rates had no significant difference between the groups (2-year CV death: 10.8% vs. 14.3%; MACE: 47.0% vs. 39.7%; Major bleeding: 8.0% vs. 9.0%, Figure). Even comparing such clinical endpoints after 1 year, significant difference was not observed between the groups. Furthermore, any other cut-off points from -1 to 7 also could not make significant difference in clinical event rates during the observational period between the groups.
Conclusions: The DAPT score is hardly adapted to the hemodialysis patients in predicting clinical adverse events and also determining who should receive prolonged dual antiplatelet therapy beyond12 months after PCI.