MedicalResearch.com Interview with:
Laura Mauri, MD,MSc
Professor, Harvard Medical School
Brigham and Women Hospital
MedicalResearch.com: What is the background for this study?
Dr. Mauri: The Dual Antiplatelet Therapy (DAPT) Study, the largest randomized controlled trial to date comparing different durations of dual antiplatelet therapy (thienopyridine plus aspirin) after coronary stenting, found that patients who were free from major ischemic or bleeding events at 1 year after coronary stenting with either drug-eluting or bare metal stents, and who were compliant with their antiplatelet therapy, experienced significant reductions in stent thrombosis and myocardial infarction (MI) but increases in moderate or severe bleeding when treated with 30 months of thienopyridine plus aspirin, as compared with 12 months. In this analysis of the DAPT Study, we wanted to determine whether the subset of patients who had a MI before the study or at the time of the index stenting procedure had different risks or benefits with long-term dual antiplatelet therapy compared to patients with no history of MI prior to or at the time of the index stenting procedure. We also wanted to evaluate whether the use of a clinical decision tool to identify patients expected to derive benefit vs. harm from continuing thienopyridine beyond one year after coronary stenting (the DAPT Score), would aid in the individualized prescription of dual antiplatelet therapy duration among these populations.
MedicalResearch.com: What are the main findings?
Dr. Mauri: Our results found that patients with previous MI have greater risk of late ischemic events (18-30 months after the index stenting procedure) than those with no MI history. We also found that DAPT Score improved prediction of patient benefit and harm from continued dual antiplatelet therapy beyond the assessment of MI history alone: Patients who had a DAPT Score ≥ 2 had a reduced risk of late MI or stent thrombosis with continued thienopyridine (vs. placebo) regardless of MI status, and no difference in bleeding risk. Conversely, patients with a DAPT Score < 2 had increased risk of late MI or stent thrombosis with continued thienopyridine (vs. placebo) regardless of MI status, and no difference in bleeding risk.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Mauri: The DAPT Score is a useful tool that can help clinicians and patients decide whether to continue dual antiplatelet therapy beyond 12 months after coronary stenting, regardless of whether the patient had a MI prior to the start of therapy. However, it should only be used with patients who, during the first 12 months of therapy, were compliant with their therapy and had no major ischemic and bleeding events.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Mauri: The DAPT Score needs to be validated prospectively in larger and more risk-diverse patient populations in order to verify its predictive accuracy. We would also like to determine whether it can accurately predict the relative benefits and risks of dual antiplatelet therapy durations of less than 1 year.
Abstract presented at the 2016 ACC Conference April 2016
Kereiakes DJ, Yeh RW, Massaro JM, et al. DAPT Score Utility for Risk Prediction in Patients With or Without Previous Myocardial Infarction. J Am Coll Cardiol. 2016;():. doi:10.1016/j.jacc.2016.03.485.