Dynamic Prognosis Prediction for Patients on DAPT After Drug-Eluting Stent Implantation: Model Development and Validation

J Am Heart Assoc. 2024 Feb 6;13(3):e029900. doi: 10.1161/JAHA.123.029900. Epub 2024 Jan 31.


Background: The rapid evolution of artificial intelligence (AI) in conjunction with recent updates in dual antiplatelet therapy (DAPT) management guidelines emphasizes the necessity for innovative models to predict ischemic or bleeding events after drug-eluting stent implantation. Leveraging AI for dynamic prediction has the potential to revolutionize risk stratification and provide personalized decision support for DAPT management.

Methods and results: We developed and validated a new AI-based pipeline using retrospective data of drug-eluting stent-treated patients, sourced from the Cerner Health Facts data set (n=98 236) and Optum's de-identified Clinformatics Data Mart Database (n=9978). The 36 months following drug-eluting stent implantation were designated as our primary forecasting interval, further segmented into 6 sequential prediction windows. We evaluated 5 distinct AI algorithms for their precision in predicting ischemic and bleeding risks. Model discriminative accuracy was assessed using the area under the receiver operating characteristic curve, among other metrics. The weighted light gradient boosting machine stood out as the preeminent model, thus earning its place as our AI-DAPT model. The AI-DAPT demonstrated peak accuracy in the 30 to 36 months window, charting an area under the receiver operating characteristic curve of 90% [95% CI, 88%-92%] for ischemia and 84% [95% CI, 82%-87%] for bleeding predictions.

Conclusions: Our AI-DAPT excels in formulating iterative, refined dynamic predictions by assimilating ongoing updates from patients' clinical profiles, holding value as a novel smart clinical tool to facilitate optimal DAPT duration management with high accuracy and adaptability.

Keywords: artificial intelligence; coronary artery disease; drug‐eluting stent implantation; dual anti‐platelet therapy; dynamic prediction.

MeSH terms

  • Artificial Intelligence
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / surgery
  • Drug Therapy, Combination
  • Drug-Eluting Stents* / adverse effects
  • Hemorrhage / chemically induced
  • Humans
  • Myocardial Infarction* / etiology
  • Percutaneous Coronary Intervention* / adverse effects
  • Platelet Aggregation Inhibitors / adverse effects
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome


  • Platelet Aggregation Inhibitors