Seung Hun Lee1,2, Hyun Kuk Kim3, Myung Ho Jeong1, Satoshi Yasuda4, Satoshi Honda4, Young-Hoon Jeong5, Joo Myung Lee2, Joo-Yong Hahn2, Jeehoon Kang6, Shung Chull Chae7, In-Whan Seong8, Jong-Seon Park9, Jei Keon Chae10, Seung-Ho Hur11, Kwang Soo Cha12, Hyo-Soo Kim6, Ki-Bae Seung13, Seung-Woon Rha14, Jin-Yong Hwang15, Dong-Ju Choi16, Seok Kyu Oh17, Sung Soo Kim3, Taek Kyu Park2, Jeong Hoon Yang2, Young Bin Song2, Seung-Hyuk Choi2, Hyeon-Cheol Gwon2. 1. Department of Cardiology, Chonnam National University Hospital, 42 Jaebong-ro, Dong-gu, Gwangju 61469, Korea. 2. Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 06351, Korea. 3. Department of Cardiology, Chosun University Hospital, 365 Pilmun-daero Dong-gu, Gwangju 61453, Korea. 4. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan. 5. Department of Internal Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Changwon 51472, Korea. 6. Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul 03080, Korea. 7. Department of Internal Medicine, Kyungpook National University Hospital, 680 gukchaebosang-ro, Jung-gu, Daegu 41944, Korea. 8. Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University, College of Medicine, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. 9. Division of Cardiology, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. 10. Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea. 11. Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, 6 Dalseong-ro, Jung-gu, Daegu 41932, Korea. 12. Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. 13. Cardiology Division, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea. 14. Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea. 15. Department of Internal Medicine, Gyeonsang National University School of Medicine, Gyeongsang National University Hospital, 79 Gangnam-ro, Jinju 52727, Korea. 16. Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, 82, Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea. 17. Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, 460 Iksandae-ro, Iksan 54538, Korea.
Abstract
AIMS: Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk. METHODS AND RESULTS: Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P < 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P < 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable. CONCLUSION: The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Potent P2Y12 inhibitors for dual antiplatelet therapy (DAPT) is crucial for managing acute myocardial infarction; however, the selection of drugs is based on limited clinical information such as age and body weight. The current study sought to develop and validate a new risk scoring system that can be used to guide the selection of potent P2Y12 inhibitors by balancing ischaemic benefit and bleeding risk. METHODS AND RESULTS: Derivation cohort of 10 687 patients who participated in the Korea Acute Myocardial Infarction Registry-National Institutes of Health study was used to construct a new scoring system. We combined the ischaemic and bleeding models to establish a simple clinical prediction score. Among the low score group (n = 1764), the observed bleeding risk (8.7% vs. 4.4%, P < 0.001) due to potent P2Y12 inhibitors exceeded ischaemic benefit (1.3% vs. 2.2%, P = 0.185) during 12 months. Conversely, the high score group (n = 1898) showed an overall benefit from taking potent P2Y12 inhibitors from the standpoint of observed ischaemic (17.1% vs. 8.6%, P < 0.001) and bleeding events (10.1% vs. 6.8%, P = 0.073). The performance of ischaemic [integrated area under the curve (iAUC) = 0.809] and bleeding model (iAUC = 0.655) was deemed to be acceptable. CONCLUSION: The new scoring system is a useful clinical tool for guiding DAPT by balancing ischaemic benefit and bleeding risk, especially among Asian populations. Further validation studies with other cohorts will be required to verify that the new system meets the needs of real clinical practice. Published on behalf of the European Society of Cardiology. All rights reserved.