Patterns and Impact of Dual Antiplatelet Cessation on Cardiovascular Risk After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes.

Published

Journal Article

The aim of this study was to examine the patterns and clinical impact of differing modes of dual-antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention (PCI) in patients presenting with and without acute coronary syndromes (ACS). The PARIS (patterns of nonadherence to antiplatelet regimens in stented patients) registry was a multicenter study of 5,018 patients who underwent PCI. DAPT cessation was categorized as physician-recommended discontinuation, interruption, or disruption. Overall rates of 2-year DAPT discontinuation did not differ between non-ACS and ACS patients (38.8% vs 37.2%, p = 0.252). ACS patients were less likely to interrupt DAPT (8.5% vs 10.7% p<0.001), but were more likely to disrupt DAPT (16.4% vs 11.9%, p<0001). Adverse events after DAPT cessation were highest after disruption, intermediate with discontinuation, and lowest with interruption across both groups. Disruption of DAPT predicted MACE in both ACS patients (hazard ratio [HR] 2.89 [1.88 to 4.45; p<0.001]) and non-ACS patients (HR 2.08 [1.29 to 3.35; p = 0.002]). Interruption of DAPT predicated MACE in ACS patients (HR 2.72 [1.35 to 5.48]) but not in non-ACS patients (HR 0.44 [0.14 to 1.40]; pinteraction≤0.01). In conclusion, the incidence of DAPT cessation mode differs by presentation with or without ACS. Physician guided DAPT discontinuation was the most common mode of DAPT cessation and appears to be safe across both groups. There were higher rates of adverse events associated with the interruption of DAPT in ACS patients.

Full Text

Duke Authors

Cited Authors

  • Schoos, M; Power, D; Baber, U; Sartori, S; Claessen, B; Camaj, A; Steg, P; Ariti, C; Weisz, G; Witzenbichler, B; Henry, T; Cohen, D; Antoniucci, D; Krucoff, M; Hermiller, J; Gibson, C; Chieffo, A; Moliterno, D; Colombo, A; Pocock, S; Dangas, G; Mehran, R

Published Date

  • March 2019

Published In

Volume / Issue

  • 123 / 5

Start / End Page

  • 709 - 716

PubMed ID

  • 30612724

Pubmed Central ID

  • 30612724

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2018.11.051

Language

  • eng