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

Figures & data

Figure 1 The flowchart of study population selection.

Table 1 Baseline Characteristics of the Two Groups

	Low/Moderate Thrombotic Risk (n=306)	High Thrombotic Risk (n=183)	P*
Admission information
Male, n (%)	212 (69.3)	131 (71.6)	0.590
Age (years)	63.2±11.4	67.7±11.0	<0.001
STEMI, n (%)	79 (25.8)	38 (20.8)	0.205
LVEF (%)	59.8±9.0	55.7±10.7	<0.001
Smoking, n (%)	85 (27.8)	51 (27.9)	0.983
History of disease, n (%)
Stroke	17 (5.6)	31 (16.9)	<0.001
Peripheral vascular disease	5 (1.6)	13 (7.1)	0.002
Hypertension	166 (54.2)	140 (76.5)	<0.001
Diabetes mellitus	82 (26.8)	69 (37.7)	0.012
Concomitant systemic inflammatory disease	2 (0.7)	1 (0.5)	0.883
Previous PCI	50 (16.3)	54 (29.5)	0.001
Previous CABG	1 (0.3)	2 (1.1)	0.294
CKD	13 (4.2)	10 (5.5)	0.539
Heart failure	3 (1.0)	19 (10.4)	<0.001
OMI	19 (6.2)	30 (16.4)	<0.001
Atrial fibrillation	14 (4.6)	8 (4.4)	0.916
Laboratory test
Uric acid (mmol/L)	375.6±112.5	391.6±120.4	0.138
Creatinine (μmol/L) [IQR]	77.6 (64.3–91.2)	83.8 (71.3–104.0)	<0.001
eGFR (mL/min/1.73m^2)	83.8±23.7	73.7±27.1	<0.001
Medication, n (%)
Statin	302 (98.7)	182 (99.5)	0.655
Ticagrelor	203 (66.3)	126 (68.9)	0.567
β-blocker	290 (94.8)	174 (95.1)	0.880
ACEI/ARB	180 (58.8)	120 (65.6)	0.138
CCB	65 (21.2)	31 (16.9)	0.246
Angiography characteristics, n (%)
1-vessel disease,	143 (46.7)	2 (1.1)	<0.001
2-vessel disease	126 (41.2)	18 (9.8)	<0.001
3-vessel disease	37 (12.1)	163 (89.1)	<0.001
Left main disease	5 (1.6)	45 (24.6)	<0.001
In-stent restenosis	2 (3.9)	17 (9.3)	0.015
CTO	16 (5.2)	41 (22.4)	<0.001
Patients with PCI	256 (83.7)	170 (92.9)	0.003
Stent diameter <3 mm	103 (33.7)	114 (62.3)	<0.001
≥3 stents implanted	39 (12.7)	102 (55.7)	<0.001
Total stent length >60 mm	77 (25.2)	120 (65.6)	<0.001

Notes: Data are shown as the mean ± standard deviation, median value (interquartile range), or percentage when appropriate. *Student’s t-test, Kruskal–Wallis test or χ² test was done when appropriate.

Abbreviations: STEMI, ST-segment elevation myocardial infarction; LVEF, Left ventricular ejection fractions; PCI, Percutaneous coronary intervention; CABG, Coronary angioplasty bypass grafting; CKD, Chronic kidney disease; OMI, Old myocardial infarction; eGFR, Estimated glomerular filtration rate; ACEI, angiotensin converting enzyme inhibitors; ARB, Angiotensin receptor blocker; CCB, Calcium channel blocker; CTO, Chronic total occlusion.

Table 2 Clinical Outcomes at Follow-Up Time

End Point		Event Rate, %	HR (95% CI)	P*
MACE
ESC criteria	Low to moderate	34 (11.1)	Ref
	High	51 (27.9)	2.75 (1.78–4.25)	<0.001
DAPT score	<2	32 (14.4)	Ref
	≥2	53 (19.9)	1.43 (0.92–2.22)	0.107
All cause death
ESC criteria	Low to moderate	11 (3.6)	Ref
	High	15 (8.2)	2.49 (1.14–5.43)	0.021
DAPT score	<2	14 (6.3)	Ref
	≥2	12 (4.5)	0.73 (0.34–1.59)	0.443
Recurrent ACS or UR
ESC criteria	Low to moderate	19 (6.2)	Ref
	High	29 (15.8)	2.80 (1.57–4.99)	<0.001
DAPT score	<2	16 (7.2)	Ref
	≥2	32 (12.0)	1.73 (0.95–3.15)	0.073
Stroke
ESC criteria	Low to moderate	4 (1.3)	Ref
	High	7 (3.8)	3.24 (0.94–11.08)	0.060
DAPT score	<2	2 (0.9)	Ref
	≥2	9 (3.4)	3.94 (0.85–18.23)	0.079

Notes: Data are shown as number and percentage. *Univariate COX regression analysis was done.

Abbreviations: MACE, Major adverse cardiovascular events; ACS, Acute coronary syndrome; UR, unplanned revascularization.

Figure 2 Landmark analysis of the Kaplan–Meier estimates of MACE within one year and after one year. (A) MACE event rates in the ESC-defined high-risk and ESC-defined low/medium-risk groups and landmark analysis within and after one year. (B) MACE event rates in the DAPT score ≥ 2 and DAPT score < 2 groups and landmark analysis within and after one year.

Table 3 Areas Under the Receiver Operating Characteristic Curves for ESC Risk Criteria, DAPT Score, and the Combination of ESC Risk Criteria and DAPT Score in Identifying MACE

	AUC (95% CI)	P-value	Sensitivity	Specificity
ESC risk criteria	0.637 (0.571–0.703)	<0.001	0.600	0.673
DAPT score	0.547 (0.480–0.614)	0.174	0.624	0.470
ESC risk criteria combine DAPT score	0.602 (0.532–0.672)	0.003	0.400	0.804

Abbreviation: AUC, Area under curve.

Table 4 To Compare the Ability of ESC Risk Criteria, DAPT Score to Predict MACE

	Comparison	z	P*
All patients	DAPT vs ESC criteria	2.300	0.020

Note: *The DeLong test was done.

Figure 3 The receiver operating characteristic (ROC) curve of the ESC criteria and DAPT score for MACE in patients with ACS.

Figure 4 Subgroup analysis of the prognostic value of the ESC criteria in different subgroups for MACE.