Inter-regional differences in outcome in unstable angina and non-Q wave myocardial infarction patients can reasonably well be explained by differences in patient characteristics. However, other so far unidentified variables present in Argentina and France also contributed to differences in outcome and their effect warrants further investigation.
facilitate treatment duration decisions, several risk assessment tools, including the DAPT and PRECISE-DAPT scores, have been developed. While the DAPT score is meant for evaluation at one-year, it is often extrapolated for use at baseline. As components of these scores differ, variability of treatment recommendation of the two assessment tools remains unknown. We set to evaluate inter-tool concordance in treatment duration recommendation in a cohort of patients after PCI. METHODS: Using data from the CAPITAL PCI registry, we calculated the DAPT and PRECISE-DAPT scores at baseline after PCI for consecutive patients with complete data to enable both scores to be calculated. Based on their DAPT and PRE-CISE-DAPT score, patients were grouped into concordant for long-term treatment (DAPT scores ! 2 and PRECISE-DAPT scores <25) or concordant for shortened treatment (DAPT <2 and PRECISE-DAPT >25). All other patients were considered discordant. We then performed a concordance analysis using Cohen's kappa to measure degree of agreement. RESULTS: Among 167 patients, the mean age was 63.6 (SD 11.8); 122 (73%) were men. Index presentation consisted of a myocardial infarction (MI) in 139 (83%) and 27 (16%) had history of a prior MI. At presentation, 81 (48%) were current smokers, 14 (8.4%) had a history of CHF or LVEF <30%, 38 (23%) had diabetes and 104 (62%) were previously diagnosed as hypertensive. Mean DAPT score was 1.75 (SD 1.31). Mean PRECISE-DAPT was 18.62 (SD 13.39). The DAPT score recommended long-term treatment for 102 (61%) and shortened treatment for 65 (39%). The PRECISE-DAPT recommended long-term treatment for 127 (76%) and shortened treatment for 40 (24%). The overall proportion of agreement between the two risk prediction tools was 62.3% with a Cohen's kappa index of 0.147 (95% CI, 0.001 to 0.293). See table below. CONCLUSION: Comparison of the DAPT score (at baseline) and the PRECISE-DAPT score showed concordance in treatment recommendation in only 62% of patients. Given the poor agreement between these tools, prospective concurrent evaluations and correlation to outcomes will be required in future studies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.