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BENEFIT AND RISK OF DUAL ANTIPLATELET THERAPY IN FEMALES: DAPT STUDY RESULTS
36 JACC April 5, 2016 Volume 67, Issue 13
ACC.i2 Interventional Cardiology BENEFIT AND RISK OF DUAL ANTIPLATELET THERAPY IN FEMALES: DAPT STUDY RESULTS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Acute Myocardial Infarction Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1105-109 Authors: Natalia Berry, Dean Kereiakes, Robert Yeh, Philippe Steg, Donald Cutlip, Wen-Hua Hsieh, Joseph Massaro, Laura Mauri, Brigham and Women’s Hospital, Boston, MA, USA Background: Females in the DAPT Study had attenuated benefit for reduction in myocardial infarction (MI) with continued thienopyridine therapy beyond 12m when compared with males (interaction p =0.03). Whether the risk/benefit relationship of prolonged dual antiplatelet therapy differs for females is unknown.
Methods: The DAPT Study was a randomized double-blind, placebo-controlled trial that compared continued thienopyridine vs. placebo beyond 12 months after drug-eluting or bare metal stents in patients receiving aspirin. We compared stent thrombosis (ST) and MI as well as moderate/severe bleeding, by sex, randomized treatment, and stratified by DAPT Score (values <2 vs ≥2 indicating bleeding risk greater than vs. less than ischemic benefit without adjustment for sex). Results: Of 11,648 randomized patients, females (N=2925) were older with a higher rate of diabetes mellitus, and lower rates of ACS or prior revascularization than males (all p<0.001). At 12-30 months after stenting, females had similar rates of ST (0.71% vs. 0.91%, p=0.23), MI (3.23% vs. 3.00%, p=0.47) and GUSTO moderate/severe bleeding (2.30% vs. 1.86%, p=0.15) compared with males. Low (<2) and high (≥2) DAPT Scores predicted ischemic benefit and bleeding risk for both females and males (Figure). Conclusions: Females had similar late risks of ischemia and bleeding as males. High DAPT Scores predict ischemic benefit from continued thienopyridine therapy (>one year) in females.
ACC.i2 Interventional Cardiology BENEFIT AND RISK OF DUAL ANTIPLATELET THERAPY IN FEMALES: DAPT STUDY RESULTS Poster Contributions Poster Area, South Hall A1 Saturday, April 02, 2016, 10:00 a.m.-10:45 a.m. Session Title: Acute Myocardial Infarction Abstract Category: 1. ACC.i2 Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1105-109 Authors: Natalia Berry, Dean Kereiakes, Robert Yeh, Philippe Steg, Donald Cutlip, Wen-Hua Hsieh, Joseph Massaro, Laura Mauri, Brigham and Women’s Hospital, Boston, MA, USA Background: Females in the DAPT Study had attenuated benefit for reduction in myocardial infarction (MI) with continued thienopyridine therapy beyond 12m when compared with males (interaction p =0.03). Whether the risk/benefit relationship of prolonged dual antiplatelet therapy differs for females is unknown.
Methods: The DAPT Study was a randomized double-blind, placebo-controlled trial that compared continued thienopyridine vs. placebo beyond 12 months after drug-eluting or bare metal stents in patients receiving aspirin. We compared stent thrombosis (ST) and MI as well as moderate/severe bleeding, by sex, randomized treatment, and stratified by DAPT Score (values <2 vs ≥2 indicating bleeding risk greater than vs. less than ischemic benefit without adjustment for sex). Results: Of 11,648 randomized patients, females (N=2925) were older with a higher rate of diabetes mellitus, and lower rates of ACS or prior revascularization than males (all p<0.001). At 12-30 months after stenting, females had similar rates of ST (0.71% vs. 0.91%, p=0.23), MI (3.23% vs. 3.00%, p=0.47) and GUSTO moderate/severe bleeding (2.30% vs. 1.86%, p=0.15) compared with males. Low (<2) and high (≥2) DAPT Scores predicted ischemic benefit and bleeding risk for both females and males (Figure). Conclusions: Females had similar late risks of ischemia and bleeding as males. High DAPT Scores predict ischemic benefit from continued thienopyridine therapy (>one year) in females.