STOPDAPT-2 Risk Subgroup Calculator
- Age (years)
- Acute coronary syndrome (ACS) presentation?
- High-bleeding-risk (HBR) criteria met?
- Complex PCI (yes/no)?
- STOPDAPT-2 ACS Risk Subgroup Calculator: Explanation and Clinical Context
The STOPDAPT-2 family of trials investigated the safety and efficacy of abbreviated dual antiplatelet therapy (DAPT) duration followed by P2Y12 inhibitor monotherapy versus standard 12-month DAPT in patients undergoing percutaneous coronary intervention (PCI) using cobalt‐chromium everolimus-eluting stents (CoCr-EES). Subgroup analyses explored how key clinical variables (such as presentation with acute coronary syndrome [ACS], high bleeding risk [HBR], and complexity of PCI) modify risks of ischemic or bleeding events, offering insight into patient stratification though not producing a formal numeric risk-score formula. In the ACS subgroup, 1- to 2-month DAPT followed by clopidogrel monotherapy did not meet noninferiority compared with 12-month DAPT for the composite endpoint, trending toward higher ischemic risk (HR ~1.50) despite reduced major bleeding (HR ~0.46) at 1-year. Accordingly, in clinical practice, patients with ACS, HBR, or complex PCI may require a more cautious DAPT approach. This calculator uses simplified multipliers to estimate a 1-year composite risk (ischemic + bleeding) based on these modifiers; it should not replace formal guideline-driven individualized decision making.
Reference:
Watanabe H, Morimoto T, Natsuaki M, et al. Comparison of Clopidogrel Monotherapy After 1 to 2 Months of Dual Antiplatelet Therapy With 12 Months of Dual Antiplatelet Therapy in Patients With Acute Coronary Syndrome: The STOPDAPT-2 ACS Randomized Clinical Trial. JAMA Cardiol. 2022;7(4):407-417. doi:10.1001/jamacardio.2021.5244.
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