DO THE DAPT AND PRECISE-DAPT SCORES PROVIDE CONCORDANT RECOMMENDATIONS FOR DURATION OF P2Y12 INHIBITOR TREATMENT AFTER PERCUTANEOUS CORONARY INTERVENTION?

Dual antiplatelet therapy (DAPT), with aspirin and a P2Y12 inhibitor, is the standard therapy for patients following percutaneous coronary intervention (PCI). Length of treatment with DAPT has been controversial despite large studies. Current guidelines recommend treatment duration to be individualized based on risk of ischemia and bleeding. To facilitate treatment duration decisions, several risk assessment tools, including the DAPT and PRECISE-DAPT scores, have been developed. While the DAPT score is meant for evaluation at one-year, it is often extrapolated for use at baseline. As components of these scores differ, variability of treatment recommendation of the two assessment tools remains unknown. We set to evaluate inter-tool concordance in treatment duration recommendation in a cohort of patients after PCI. Using data from the CAPITAL PCI registry, we calculated the DAPT and PRECISE-DAPT scores at baseline after PCI for consecutive patients with complete data to enable both scores to be calculated. Based on their DAPT and PRECISE-DAPT score, patients were grouped into concordant for long-term treatment (DAPT scores ≥ 2 and PRECISE-DAPT scores <25) or concordant for shortened treatment (DAPT <2 and PRECISE-DAPT >25). All other patients were considered discordant. We then performed a concordance analysis using Cohen’s kappa to measure degree of agreement. Among 167 patients, the mean age was 63.6 (SD 11.8); 122 (73%) were men. Index presentation consisted of a myocardial infarction (MI) in 139 (83%) and 27 (16%) had history of a prior MI. At presentation, 81 (48%) were current smokers, 14 (8.4%) had a history of CHF or LVEF <30%, 38 (23%) had diabetes and 104 (62%) were previously diagnosed as hypertensive. Mean DAPT score was 1.75 (SD 1.31). Mean PRECISE-DAPT was 18.62 (SD 13.39). The DAPT score recommended long-term treatment for 102 (61%) and shortened treatment for 65 (39%). The PRECISE-DAPT recommended long-term treatment for 127 (76%) and shortened treatment for 40 (24%). The overall proportion of agreement between the two risk prediction tools was 62.3% with a Cohen’s kappa index of 0.147 (95% CI, 0.001 to 0.293). See table below. Comparison of the DAPT score (at baseline) and the PRECISE-DAPT score showed concordance in treatment recommendation in only 62% of patients. Given the poor agreement between these tools, prospective concurrent evaluations and correlation to outcomes will be required in future studies.