Assessing the Utility of the DAPT Score and PRECISE-DAPT Score in Determining the Appropriateness of Dual Antiplatelet Therapy in Patients With Acute Myocardial Infarction/Percutaneous Coronary Intervention.

Abstract

Background: Utilizing the two available prediction models, i.e., the dual antiplatelet therapy (DAPT) score and predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score, we aimed to determine the appropriateness of the DAPT in patients with acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI). Methods: We retrospectively enrolled 235 patients of AMI and for all the patients and thorough information regarding history, risk factors, and medications were collected. Both DAPT and PRECISE-DAPT scores were calculated. The patients were divided by their recommended cutoffs and the appropriateness of the duration of the recommended DAPT was measured based on the observed scores. Bleeding academic research consortium (BARC) classification was used to define the bleeding events. In the patients with DAPT score ≥ 2 and PRESICE-DAPT < 25, the prolonged use of DAPT was recommended. Results: Overall, 235 patients, predominantly male (78.7%), with baseline characteristics exhibiting high rate of smoking (31.1%), diabetes (35.3%), and hypertension (32.8%) were found. The widely prescribed DAPT combination was aspirin with clopidogrel (72.3% at discharge and 46% on current use). Among all the enrolled patients, 163 patients were on DAPT while 71 were on single antiplatelet therapy (SAPT). A significant association between DAPT and PRECISE-DAPT scores was noted in terms of SAPT and DAPT. The appropriateness of DAPT was checked based on the scores, where 81% of the patients with DAPT ≥ 2 and 77.24% with PRECISE-DAPT score < 25 were appropriately prescribed with DAPT. The primary reason for drug interruptions was self-advised. The incidence of bleeding events was observed to be 7.23%, among which 5.1% had Type 1 bleeding according to BARC. Conclusion: Both DAPT and PRECISE-DAPT scores could be used to determine the appropriateness of the recommendations of DAPT in patients with AMI or undergoing PCI.