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Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients).

Publication ,  Journal Article
Baber, U; Li, SX; Pinnelas, R; Pocock, SJ; Krucoff, MW; Ariti, C; Gibson, CM; Steg, PG; Weisz, G; Witzenbichler, B; Henry, TD; Kini, AS ...
Published in: Circ Cardiovasc Interv
March 2018

BACKGROUND: Patients with chronic kidney disease (CKD) experience high rates of ischemic and bleeding events after percutaneous coronary intervention (PCI), complicating decisions surrounding dual antiplatelet therapy (DAPT). This study aims to determine the pattern and impact of various modes of DAPT cessation for patients with CKD undergoing PCI. METHODS AND RESULTS: Patients from the PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were grouped based on the presence of CKD defined as creatinine clearance <60 mL/min. After index PCI, time and mode of DAPT cessation (discontinuation, interruption, and disruption) and clinical outcomes (major adverse cardiac events, stent thrombosis, myocardial infarction, and major bleeding [Bleeding Academic Research Consortium type 3 or 5]) were reported. Over 2 years, patients with CKD (n=839) had higher adjusted risks for death (hazard ratio, 3.16; 95% confidence interval, 2.26-4.41), myocardial infarction (hazard ratio, 2.43; 95% confidence interval, 1.65-3.57), and major bleeding (hazard ratio, 2.21; 95% confidence interval, 1.53-3.19) compared with patients without CKD (n=3745). Rates of DAPT discontinuation within the first year after PCI and disruption were significantly higher for patients with CKD. However, DAPT interruption occurred with equal frequency. Associations between DAPT cessation mode and subsequent risk were not modified by CKD status. Findings were unchanged after propensity matching. CONCLUSIONS: Patients with CKD display high and comparable risks for both ischemic and bleeding events after PCI. Physicians are more likely to discontinue DAPT within the first year after PCI among patients with CKD, likely reflecting clinical preferences to avoid bleeding. Risks after DAPT cessation, irrespective of underlying mode, are not modified by the presence or absence of CKD.

Duke Scholars

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

March 2018

Volume

11

Issue

3

Start / End Page

e006144

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Thrombosis
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Registries
  • Prospective Studies
  • Practice Patterns, Physicians'
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Baber, U., Li, S. X., Pinnelas, R., Pocock, S. J., Krucoff, M. W., Ariti, C., … Mehran, R. (2018). Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv, 11(3), e006144. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006144
Baber, Usman, Shawn X. Li, Rebecca Pinnelas, Stuart J. Pocock, Mitchell W. Krucoff, Cono Ariti, C Michael Gibson, et al. “Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients).Circ Cardiovasc Interv 11, no. 3 (March 2018): e006144. https://doi.org/10.1161/CIRCINTERVENTIONS.117.006144.
Baber U, Li SX, Pinnelas R, Pocock SJ, Krucoff MW, Ariti C, Gibson CM, Steg PG, Weisz G, Witzenbichler B, Henry TD, Kini AS, Stuckey T, Cohen DJ, Iakovou I, Dangas G, Aquino MB, Sartori S, Chieffo A, Moliterno DJ, Colombo A, Mehran R. Incidence, Patterns, and Impact of Dual Antiplatelet Therapy Cessation Among Patients With and Without Chronic Kidney Disease Undergoing Percutaneous Coronary Intervention: Results From the PARIS Registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients). Circ Cardiovasc Interv. 2018 Mar;11(3):e006144.

Published In

Circ Cardiovasc Interv

DOI

EISSN

1941-7632

Publication Date

March 2018

Volume

11

Issue

3

Start / End Page

e006144

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Time Factors
  • Thrombosis
  • Risk Factors
  • Risk Assessment
  • Renal Insufficiency, Chronic
  • Registries
  • Prospective Studies
  • Practice Patterns, Physicians'