Yeh et al reported a risk score for evaluating a patient with a history of percutaneous coronary intervention (PCI) and dual antiplatelet therapy. This can help to decide what antiplatelet therapy should be continued in the patient. The study is based on the DAPT clinical trial with numerous investigators in the United States, Europe, Australia and New Zealand.
Patient selection: PCI and dual antiplatelet therapy (thienopyridine, aspirin) for 12 months, then randomized to 18 months of aspirin with or without thienopyridine
Outcomes 12-30 months after PCI: (1) moderate or severe bleeding, (2) AMI or stent thrombosis
Parameters:
(1) age in years
(2) cigarette smoking within year before PCI
(3) diabetes mellitus
(4) acute myocardial infarction (AMI) at presentation
(5) history of previous PCI or AMI
(6) paclitaxel-eluting stent
(7) stent diameter < 3 mm
(8) CHF or LVEF < 30%
(9) stent in vein graft
|
Parameter |
Finding |
Points |
|
age in years |
< 65 years |
0 |
|
|
65 to 74.99 |
-1 |
|
|
>= 75 years |
-2 |
|
cigarette smoking |
no |
0 |
|
|
yes |
1 |
|
diabetes mellitus |
no |
0 |
|
|
yes |
1 |
|
AMI at presentation |
no |
0 |
|
|
yes |
1 |
|
history of previous PCI or AMI |
no |
0 |
|
|
yes |
1 |
|
paclitaxel-eluting stent |
no |
0 |
|
|
yes |
1 |
|
stent diameter |
< 3 mm |
1 |
|
|
>= 3 mm |
0 |
|
CHF or LVEF < 30% |
no |
0 |
|
|
yes |
2 |
|
stent in vein graft |
no |
0 |
|
|
yes |
2 |
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: -2
• maximum score: 10
• A score < 2 was considered low risk and a score >= 2 was high risk for poor outcome.
Specialty: Cardiology
