Prognostic Role of the Precise DAPT Score on Long-Term Outcomes After Carotid Artery Stenting: A Retrospective Cohort Study.

Abstract

Background: Carotid artery stenosis is a major contributor to stroke, a leading cause of mortality and disability worldwide. Carotid artery stenting (CAS) is commonly performed to reduce the risk of stroke in affected individuals. The Precise DAPT score, originally designed to predict bleeding risk in percutaneous coronary intervention (PCI) patients, has shown potential in predicting adverse outcomes in other vascular interventions.

Aim: This study investigates the role of the Precise DAPT score associated with short- and long-term clinical outcomes in patients undergoing CAS.

Methods: A retrospective cohort study was conducted using data from 376 patients who underwent CAS at Health Sciences University Siyami Ersek Thoracic and Cardiovascular Surgery Center between December 2012 and January 2018. The study analyzed the relationship between the Precise DAPT score and short- and long-term outcomes, including peri-procedural complications, recurrent stroke, and mortality. Statistical analyses included Cox regression, survival analysis, and receiver operating characteristic (ROC) curves.

Results: Patients were stratified into two groups based on their Precise DAPT score: high score (≥ 25) and low score (< 25). After a mean follow-up of 54.3 months, those in the high-score group exhibited significantly higher long-term all-cause mortality (36.3% vs. 6.1%, p < 0.001) and major stroke events (18.6% vs. 9.1%, p = 0.01). The high-score group also had worse renal function and were older. A multivariable Cox regression model demonstrated that the Precise DAPT score ≥ 25 was associated with long-term mortality (adjusted HR 4.82, 95% CI 2.75-8.45, p < 0.001) and major stroke (adjusted HR 2.11, 95% CI 1.14-3.92, p = 0.018).

Conclusions: The Precise DAPT score, despite being designed for PCI patients, is a valuable prognostic tool in patients undergoing CAS. It is independently associated with both long-term mortality and major stroke, highlighting its potential to guide personalized therapeutic strategies. These findings suggest that integrating the Precise DAPT score into clinical practice may enhance the management of patients undergoing carotid interventions, particularly in risk stratification for bleeding and ischemic events.