Impact of the Dual Antiplatelet Therapy Score on Clinical Outcomes in Acute Coronary Syndrome Patients Receiving P2Y12 Inhibitor Monotherapy

Sheng Wei Huang, Po Wei Chen, Wen Han Feng, I. Chang Hsieh, Ming Yun Ho, Chung Wei Cheng, Hung I. Yeh, Ching Pei Chen, Wei Chun Huang, Ching Chang Fang, Hui Wen Lin, Sheng Hsiang Lin, Chin Feng Tsai, Chun Hung Su*, Yi Heng Li*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review


Background: Dual antiplatelet therapy (DAPT) score is used to stratify ischemic and bleeding risk for antiplatelet therapy after percutaneous coronary intervention (PCI). This study assessed the association between the DAPT score and clinical outcomes in acute coronary syndrome (ACS) patients who were treated with P2Y12 inhibitor monotherapy. Methods: A total of 498 ACS patients, with early aspirin discontinuation for various reasons and who received P2Y12 inhibitor monotherapy after PCI, were enrolled during the period from January 1, 2014 to December 31, 2018. The efficacy and safety between those with low (<2) and high (≥2) DAPT scores were compared during a 12-month follow-up after PCI. Inverse probability of treatment weighting was used to balance the covariates between the two groups. The primary endpoint was a composite outcome of all-cause mortality, recurrent ACS or unplanned revascularization, and stroke within 12 months. The safety endpoint was major bleeding, defined as Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding. Results: The primary composite endpoint occurred in 11.56 and 14.38% of the low and high DAPT score groups, respectively. Although there was no significant difference in the primary composite endpoint between the two groups in the multivariate Cox proportional hazards models, the risk of recurrent ACS or unplanned revascularization was significantly higher in the high DAPT score group (adjusted hazard ratio [HR]: 1.900, 95% confidence interval [CI]: 1.095–3.295). The safety outcome for BARC 3 or 5 bleeding was similar between the two groups. Conclusions: Our results indicate that ACS patients receiving P2Y12 monotherapy with high DAPT score had an increased risk of recurrent ACS or unplanned revascularization.

Original languageEnglish
Article number772820
JournalFrontiers in Cardiovascular Medicine
StatePublished - 2021

Bibliographical note

Publisher Copyright:
Copyright © 2022 Huang, Chen, Feng, Hsieh, Ho, Cheng, Yeh, Chen, Huang, Fang, Lin, Lin, Tsai, Su and Li.


  • DAPT score
  • P2Y12 inhibitor
  • P2Y12 inhibitor monotherapy
  • acute coronary syndrome
  • clinical outcome


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