P067 - GUIDING POST-PCI THERAPY WITH THE DAPT SCORE: INSIGHTS FROM A DEDICATED POST-INTERVENTIONAL FOLLOW-UP CLINIC

Background: The optimal duration of DAPT after PCI remains uncertain. The DAPT score, developed as a decision aid for DAPT duration, optimizes the risk of bleeding and ischemic events. The DAPT score had been routinely used in our one-year post-PCI clinic to guide antiplatelet decisions. The aim of this retrospective cohort study was to determine the association between prospectively determined DAPT scores, antiplatelet duration, and clinical outcomes in the context of an all-comers post PCI clinic.

METHODS AND RESULTS: Over a one-year period, consecutive patients >18 years old who underwent PCI and attended their 12-month post-PCI follow-up were included. Patients were excluded if they had an indication for oral anticoagulation. Chart review was performed, and patients were contacted by telephone at 24-36 months post-PCI to further ascertain outcomes. The primary outcome was Net Adverse Clinical Events (NACE), a composite of Major Adverse Cardiovascular Events (MACE) and Bleeding Academic Research Consortium (BARC) Type 3 to 5 major bleeding. The MACE outcome included target vessel revascularization, stroke, myocardial infarction, and cardiovascular death. Logistic regression analyses assessed the relationship between predictor variables and outcomes. To compare NACE outcomes based on DAPT score and antiplatelet regimen congruence, a Wilcoxon Rank Sum test was used, with significance set at p< 0.05.

Of 910 patients included, 893 had sufficient data for the primary NACE analysis (Table 1). NACE in those with DAPT score concordant antiplatelet regimens (i.e., prolonged DAPT with DAPT score ≥ 2 and aspirin only for DAPT < 2) was significantly lower than those with DAPT score discordant antiplatelet regimens (54/834 (6.5%) vs. 15/59 (25.4%), p< 0.001, Figure 1). By logistic regression analyses, no significant association between the DAPT score and MACE was shown (OR 1.14; 95% C.I. 0.60-2.08 for univariate; OR 1.21; 95% CI 0.61-2.32 for multivariate). Similarly, there was no significant association demonstrated between DAPT score and bleeding (OR 1.76 95% CI 0.34 – 8.03 for univariate; OR 2.06 95% CI 0.37 to 10.18 for multivariate).

Conclusion: In this study, a prospectively determined DAPT score at one year post PCI was not associated with ischemic or bleeding outcomes. However, patients prescribed DAPT regimens concordant with their DAPT score were shown to have significantly lower net ischemic/bleeding events compared to those prescribed DAPT score discordant regimens. These results suggest that the DAPT score guided prescription of long-term antiplatelet therapy may help reduce adverse outcomes.