ヤマグチ ジユンイチ   YAMAGUCHI JUNICHI
  山口 淳一
   所属   医学部 医学科(東京女子医科大学病院)
   職種   特任教授
言語種別 日本語
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 第81回日本循環器学会学術集会
主催者 Japanese Circulation Society
学会区分 全国規模の学会
発表形式 口頭
講演区分 一般
発表者・共同発表者◎神林敬悟, 重城健太郎, 大槻尚男, 山口淳一, 萩原誠久
発表年月日 2017/03/19
開催地
(都市, 国名)
金沢市
学会抄録 第81回日本循環器学会学術集会 プログラム集 385
概要 INTRODUCTION: DAPT score with cut‒off value of 2‒point is reported to have clinical benefits in predicting thrombotic and bleeding events after percutaneous coronary intervention (PCI). However, there has been little report testing the impact of DAPT score on hemodialysis patients as the highest‒risk population.
METHODS: This study included 239 consecutive hemodialysis patients receiving P2Y12‒inhibitors and aspirin for at least 12 months after PCI. DAPT score was graded from ‒2 to 10 points at the time of PCI. During follow‒up period of 730 days, the incidences 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 high‒DAPT patients (score ≥2, n=146) and low‒DAPT patients (score <2,n=93).
RESULTS: High‒DAPT group included younger diabetic patients with impaired left ventricular ejection fraction, compared to low‒DAPT group. Prior ischemic event rates were similar 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%). Furthermore, any other cut‒off points from ‒1 to 7 could not make significant difference in clinical event rates.
CONCLUSION: In hemodialysis patients, DAPT score is hardly adapted in predicting clinical adverse events, and in determining who should receive prolonged dual antiplatelet therapy.