The dual antiplatelet therapy (DAPT) score was developed to identify patients who would derive benefit or harm from prolonged DAPT by simultaneously predict thrombotic and hemorrhagic risk. Data on whether prolonged DAPT beyond 1 year guided by the DAPT score can reduce ischemic events in real-world population are relatively scant and controversial.

Between January 2013 and December 2013, 9203 consecutive patients who were event free (no death, myocardial infarction [MI], stroke, stent thrombosis [ST], any revascularization, or major bleeding) at 12 months after PCI with drug-eluting stents (DES) were prospectively included in the Fuwai PCI Registry. We compared the rates of major adverse cardiac and cerebrovascular events [MACCE] (a composite of all-cause death, MI, or stroke) and BARC type 2, 3 or 5 bleeding between DAPT>1-year versus DAPT≤1-year group stratified by DAPT score category (≥2 versus <2) during the period from 12 to 30 months.

By multivariable Cox regression models, insubjects with DAPT scores≥2, the rate of MACCE was 1.3% for DAPT>12 months versus 3.3% for DAPT<12-month groups (HR: 0.34, 95% CI: 0.23-0.50), whereas for subjects with DAPT scores<2, the corresponding rates were 1.5% vs. 3.6%, respectively (HR: 0.42, 95% CI: 0.27-0.64; P_interaction=0.572), adjusting for age, sex, BMI, smoking, hypertension, diabetes, CKD, ACS presentation, prior revascularization (PCI or CABG), type of stent, anemia, thrombocytopenia, and warfarin at discharge. The relative risk of BARC major bleeding associated with DAPT>12-month was similar for patients with and without higher DAPT scores (with DAPT scores≥2, 1.2% vs. 1.0%; HR: 1.20, 95% CI: 0.67-2.17; with DAPT scores<2, 1.1% vs. 1.6%; HR: 0.68, 95% CI: 0.39-1.18; P_interaction=0.194).

In a large, unselected real-world population of patients receiving DES in China, the association of DAPT duration with ischemic and bleeding events did not correspond to the suggestion decision rule of DAPT score. Better tools are warranted to identify subjects most likely to benefit from extending DAPT for>12 months after DES implantation.