ARASHI Hiroyuki
   Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine
   Position   Assistant Professor
Language English
Title Dapt Score Does Not Predict Clinical Outcomes in Hemodialysis Patients on Prolonged Dual Antiplatelet Therapy After Coronary Intervention
Conference AHA 2016 (American Heart Associations Scientific Sessions 2016)
Promoters American Heart Associations
Conference Type International society and overseas society
Presentation Type Poster notice
Lecture Type General
Publisher and common publisher◎TANAKA Kazuki, JUJO Kentaro, OOTSUKI Hisao, SHIMAZAKI Kensuke, NAKAO Masashi, ARASHI Hiroyuki, YAMAGUCHI Junichi, HAGIWARA Nobuhisa
Date 2016/11/14
(city and name of the country)
New Orleans, USA
Summary Abstract

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.