Kerr, Andrew JChoi, YeunhyangWilliams, Michael J AStewart, Ralph A HWhite, Harvey DDevlin, GerrySelak, VanessaLee, Mildred Ai WeiEl-Jack, SeifAdamson, Philip DFairley, SarahJackson, Rodney TPoppe, Katrina2025-04-032025-04-032023-11(2023). Heart, 109(24), 1827-1836.1355-6037https://hdl.handle.net/2292/71737<h4>Objective</h4>The recommended duration of dual anti-platelet therapy (DAPT) following acute coronary syndrome (ACS) varies from 1 month to 1 year depending on the balance of risks of ischaemia and major bleeding. We designed paired ischaemic and major bleeding risk scores to inform this decision.<h4>Methods</h4>New Zealand (NZ) patients with ACS investigated with coronary angiography are recorded in the All NZ ACS Quality Improvement registry and linked to national health datasets. Patients were aged 18-84 years (2012-2020), event free at 28 days postdischarge and without atrial fibrillation. Two 28-day to 1-year postdischarge multivariable risk prediction scores were developed: (1) cardiovascular mortality/rehospitalisation with myocardial infarction or ischaemic stroke (ischaemic score) and (2) bleeding mortality/rehospitalisation with bleeding (bleeding score).<h4>Findings</h4>In 27 755 patients, there were 1200 (4.3%) ischaemic and 548 (2.0%) major bleeding events. Both scores were well calibrated with moderate discrimination performance (Harrell's c-statistic 0.75 (95% CI, 0.74 to 0.77) and 0.69 (95% CI, 0.67 to 0 .71), respectively). Applying these scores to the 2020 European Society of Cardiology ACS antithrombotic treatment algorithm, the 31% of the cohort at elevated (>2%) bleeding and ischaemic risk would be considered for an abbreviated DAPT duration. For those at low bleeding risk, but elevated ischaemic risk (37% of the cohort), prolonged DAPT may be appropriate, and for those with low bleeding and ischaemic risk (29% of the cohort) short duration DAPT may be justified.<h4>Conclusion</h4>We present a pair of ischaemic and bleeding risk scores specifically to assist clinicians and their patients in deciding on DAPT duration beyond the first month post-ACS.ElectronicItems in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher.https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htmHumansBrain IschemiaIschemiaHemorrhagePlatelet Aggregation InhibitorsTreatment OutcomeDrug Therapy, CombinationAftercarePatient DischargeRisk AssessmentRisk FactorsStrokeAcute Coronary SyndromePercutaneous Coronary Intervention32 Biomedical and Clinical Sciences3201 Cardiovascular Medicine and Haematology3202 Clinical SciencesHematologyAtherosclerosisPatient SafetyHeart DiseaseCardiovascularHeart Disease - Coronary Heart Disease6.1 Pharmaceuticals4.2 Evaluation of markers and technologiesScience & TechnologyLife Sciences & BiomedicineCardiac & Cardiovascular SystemsCardiovascular System & CardiologyDUAL ANTIPLATELET THERAPYST-SEGMENT-ELEVATIONMYOCARDIAL-INFARCTIONGUIDELINESMANAGEMENTVALIDATIONIMPLEMENTATIONCOMPLICATIONSCLOPIDOGRELMORTALITY1102 Cardiorespiratory Medicine and Haematology1103 Clinical SciencesJournal Article10.1136/heartjnl-2023-322830Copyright: The authors37558394 (pubmed)1468-201Xheartjnl-2023-322830Attribution-NonCommercial 4.0 Internationalhttp://creativecommons.org/licenses/by-nc/4.0/