Performance of DAPT Score and ESC Criteria for Predicting Clinical Outcomes in Chinese Patients with Acute Coronary Syndrome

Abstract

Purpose

The values of European Society of Cardiology (ESC) criteria and dual antiplatelet therapy (DAPT) score in the stratification of ischemic risk were assessed in this study.

Methods

A total of 489 patients with acute coronary syndrome who received DAPT at discharge between June 2020 and August 2020 were enrolled. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE), which included recurrent ACS or unplanned revascularization, all-cause death, or ischemic stroke during a 27-month follow-up period.

Results

Patients with ESC-defined high-risk showed a significantly higher risk of MACE (HR 2.75, 95% CI 1.78–4.25), all-cause death (HR 2.49, 95% CI 1.14–5.43), and recurrent ACS or unplanned revascularization (HR 2.80, 95% CI 1.57–4.99) than those with ESC-defined low/medium-risk during follow-up. The results of landmark analysis showed that patients in the high-risk group had a significantly higher risk of MACE (HR 2.80,95 CI% 1.57–4.97), recurrent ACS or unplanned revascularization (HR 3.19,95 CI% 1.47–6.93) within one year, and a higher risk of MACE (HR 2.69,95 CI% 1.38–5.23) after one year. There was no significant difference in the incidence of MACE between patients with a DAPT score ≥2 and a DAPT score <2. The C-indices of ESC criteria and DAPT score for prediction of MACE were 0.63 (95% CI 0.57–0.70) and 0.54 (95% CI 0.48–0.61), respectively. The predictive value of ESC criteria for MACE was better than the DAPT score according to the DeLong test (z-statistic=2.30, P=0.020).

Conclusion

Patients with ESC-defined high-risk had a higher risk of MACE compared to those with ESC-defined low/medium-risk. The discriminant ability of the ESC criteria was better than the DAPT score for MACE. The ESC criteria demonstrated moderate discriminatory capacity of MACE in ACS patients treated with DAPT.

Keywords:

• acute coronary syndrome
• ESC criteria
• DAPT score
• platelet inhibitors
• clinical outcome

Ethics Approval

This study was approved by the Institutional Review Board of the Second Affiliated Hospital of Nanchang University. Written informed consent was acquired from all participants for their participation in our study. We confirmed that our study complies with the Declaration of Helsinki.

Consent to Participate

Informed consent was obtained from all individual participants included in the study.

Disclosure

The authors have no relevant financial or non-financial interests to disclose for this work.

Additional information

Funding

This work was supported by the Jiangxi Provincial Natural Science Foundation of China (NO.20181BAB205083). The source of funding did not have any impact on study design; analysis and interpretation of data or writing of the manuscript.