The Evaluation And Application Of PRECISE-DAPT And DAPT Score In The Duration Of Dual Antiplatelet Therapy In Elderly Patients After PCI

Objective: To analyze the distribution of bleeding/ischemic risk stratification of DAPT and PRECISE-DAPT scoring systems and describe the application of these two scoring systems in evaluating the duration of dual antiplatelet therapy in elderly patients with PCI in our hospital.Methods: This study collected clinical information of elderly patients(>65 years old)who had successfully received coronary artery stent implantation from December 2015 to December 2017 in the Department of Cardiology and cardiothoracic surgery of a third-level hospital in Xinjiang.After stent implantation,the PRECISE-DAPT score was calculated.After 12 months of dual antiplatelet therapy,the DAPT score was calculated and the PRECISE-DAPT and DAPT scoring system were analyzed.Distribution of risk stratification of bleeding/ischemia in elderly patients with PCI in our hospital;PRECISE-DAPT and DAPT scores were used to predict the time limit of dual antiplatelet therapy;the actual time limit of dual antiplatelet therapy was recorded during follow-up,and the difference between the estimated time limit and the actual time limit was compared;the occurrence and distribution of bleeding and adverse cardiovascular events were followed up and analyzed.Results: Clinical information of 372 elderly patients with coronary stenting was collected.After an average follow-up of 14.7 months,365(98.2%)were followed up successfully,and 8(2.2%)died.1.Basic information: The average age of the patients was 71.8±4.1 years,males 215(57.8%),161(43.3%)with acute myocardial infarction,103(27.7%)patients with emergency PCI,231(62.1%)patients with hypertension,116(31.2%)patients with diabetes,114(30.6%)with smoking,11(3.0%)patients with family history of coronary heart disease,blood cholesterol level was 4.07±0.93mmol/L,triglyceride level was 1.37±0.75mmol/L and low density lipoprotein C level was 2.49±0.77mmol/L.Postoperative antiplatelet drugs: aspirin combined with clopidogrel in 257(69.1%)and aspirin combined with ticagrelor in 101(27.2%).2.Distribution and application of PRECISE-DAPT and DAPT score: 261(70.2%)with PRECISE-DAPT score <25,111(29.8%)with PRECISE-DAPT score ≥25,55(16.6%)with DAPT score ≥2 and 276(83.4%)with DAPT score <2.According to the score of PRECISE-DAPT score,the actual duration of DAPT treatment in each group was observed.In patients with PRECISE-DAPT score ≥25,4(3.8%)patients’ actual duration of dual antiplatelet therapy out-hospital was between 3 and 6 months.235(92.9%)with PRECISE-DAPT score <25 had the actual duration of dual antiplatelet therapy beyond 12 months.According to the DAPT score,the actual duration of DAPT treatment in each group was observed.159(57.6%)with DAPT score <2 had actual duration of dual antiplatelet therapy 12 months out-hospital,and 14(25.5%)with DAPT score ≥2 had 12-30 months’ actual duration of dual antiplatelet therapy outside hospital.3.Analysis of hemorrhagic events and major adverse cardiovascular events: 62(16.7%)cases had hemorrhagic events and 80(21.5%)cases had adverse cardiovascular events during follow-up.Hemorrhagic events and adverse cardiovascular events were mainly distributed within 1 year after PCI.Combined with the distribution of DAPT score and PRECISE-DAPT score in elderly patients with PCI in our hospital,the incidence of hemorrhagic events in DAPT treatment after PCI was more distributed in the stratification of DAPT score <2,and the distribution of adverse cardiovascular events was more in the stratification of DAPT score <2.Hemorrhagic events were more distributed in the stratification of PRECISE-DAPT score <25,and adverse cardiovascular events were more distributed in the stratification of PRECISE-DAPT score <25.Conclusion: 1.The PRECISE-DAPT score of the elderly patients with PCI in our hospital was mainly distributed in the PRECISE-DAPT score <25 group,while the DAPT score of the elderly patients was mainly distributed in the DAPT score <2 group.2.The predicted time limit of dual antiplatelet therapy by PRECISE-DAPT and DAPT scoring system is different from that of real treatment in our hospital.The difference is obvious in groups of PRECISE-DAPT(> 25 points)and DAPT(> 2 points).In groups of PRECISE-DAPT(> 25 points),the real time limit of DAPT is longer than that of prediction,and in groups of DAPT(> 2 points),the real time limit of DAPT is shorter than that of prediction.