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Validation of DAPT Score (Dual Antiplatelet Therapy) in East Asian Patients

Article, see p 551 

In this issue of Circulation , Yoshikawa et al1 provide important information about the validity of the DAPT score (Dual Antiplatelet Therapy)2 for the prediction of future ischemic events in Japanese patients after implantation of drug-eluting stents. The original DAPT trial3 did not include patients from East Asian countries. Thus, the work by Yoshikawa et al is the first validation of the DAPT score in East Asian patients. In the present study, patients with multiple risk factors, including diabetes mellitus, cigarette smoking, and history of heart failure, in addition to local thrombogenic conditions related to smaller stent diameter or vein graft stenting, were at high risk of ischemic events. The data provided by Yoshikawa et al confirmed the robustness of the DAPT score even in patients outside the DAPT trial.

Lower ischemic risks have been seen in Japanese patients compared with patients from other countries in previous registries of stable outpatients with or at risk for atherothrombotic complications, even after adjustment for known risk factors.4 Yoshikawa et al confirmed overall low ischemic risk in their study population, who were stable during the first 13 months after successful drug-eluting stent implantation, without myocardial infarction (MI), stent thrombosis, or serious bleeding.1 Despite the use of the same definition of the primary ischemic end point (the composite of MI and definite/probable stent thrombosis5), the cumulative 3-year incidence of ischemic events of 1.5% in patients with a high DAPT score shown in the Yoshikawa et al registry was even lower than the event rate of 1.7% seen in 18 months of follow-up of patients with low DAPT scores with continuous dual antiplatelet therapy in the original DAPT trial.2

The limitations of the indirect comparison between the Yoshikawa et al registry and the DAPT …