Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)

Sabato Sorrentino; Gennaro Giustino; Usman Baber; Samantha Sartori; David J. Cohen; Timothy D. Henry; Serdar Farhan; Madhav Sharma; Cono Ariti; George Dangas; Michael Gibson; Michela Faggioni; Mitchell W. Krucoff; Melissa Aquino; Jaya Chandrasekhar; David J. Moliterno; Antonio Colombo; Birgit Vogel; Alaide Chieffo; Annapoorna S. Kini; Bernhard Witzenbichler; Giora Weisz; Philippe Gabriel Steg; Stuart Pocock; Roxana Mehran

doi:10.1016/j.amjcard.2018.07.041

Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)

Sabato Sorrentino, Gennaro Giustino, Usman Baber, Samantha Sartori, David J. Cohen, Timothy D. Henry, Serdar Farhan, Madhav Sharma, Cono Ariti, George Dangas, Michael Gibson, Michela Faggioni, Mitchell W. Krucoff, Melissa Aquino, Jaya Chandrasekhar, David J. Moliterno, Antonio Colombo, Birgit Vogel, Alaide Chieffo, Annapoorna S. KiniBernhard Witzenbichler, Giora Weisz, Philippe Gabriel Steg, Stuart Pocock, Roxana Mehran

Research output: Contribution to journal › Article › peer-review

16 Scopus citations

Abstract

The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (p_interaction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.

Original language	English
Pages (from-to)	1638-1646
Number of pages	9
Journal	American Journal of Cardiology
Volume	122
Issue number	10
DOIs	https://doi.org/10.1016/j.amjcard.2018.07.041
State	Published - Nov 15 2018

Bibliographical note

Funding Information:
DC has received research grant support from Eli Lilly and Astra Zeneca, consulting fees from Eli Lilly, Astra Zeneca, and speaking honoraria from Astra Zeneca. TH has received research grant support from Eli Lilly & Company and Daiichi-Sankyo. GD has received consulting fees and honoraria from Johnson & Johnson, Sanofi, Covidien, The Medicines Company, Merck, CSL Behring, AstraZeneca, Medtronic, Abbott, Bayer, Boston Scientific, Osprey Medical, and GE Healthcare; and research grant support from Sanofi, Bristol-Myers Squibb, and Eli Lilly & Company/Daiichi-Sankyo. MG has received research grant support from Angel Medical Corporation, Atrium Medical Systems, Bayer Corporation, Ikaria, Janssen/Johnson & Johnson Corporation, Lantheus Medical Imaging, Merck & Company, Portola Pharmaceuticals, Roche Diagnostics, Sanofi, Stealth Peptides, St. Jude Medical, Volcano Corporation, and Walk Vascular; consulting fees from AstraZeneca, Baxter Healthcare, Bayer Corporation, CRF, Consensus Medical Communications, CSL Behring, Cytori Therapeutics, Eli Lilly & Company/Daiichi Sankyo, Exeter Group, Genentech, GlaxoSmithKline, Janssen/Johnson & Johnson Corporation, Ortho McNeil, St. Jude Medical, and The Medicines Company; and royalty fees from UpToDate in Cardiovascular Medicine. DJM has received institutional research grant support from AstraZeneca. MK has received consulting fees from Abbott Vascular, Abbott laboratories, OrbusNeich, Angelmed, Volcano, Biosensors, Svelte, OrbusNeich, Medtronic, and Terumo; and research grant support from Abbott, Terumo, Angelmed, Ikaria, OrbusNeich, Cardiovascular Systems, Inc. (CSI), Eli Lilly & Company and Medtronic. AC has received consulting fees and honoraria from Carbostent and Implantable Devices (CID); and other fees from Direct Flow Medical. AK serves on the speaker's bureau of the American College of Cardiology; and has received consulting fees from WebMD. PGS discloses the following relation: research grant from Bayer, Merck, Sanofi, and Servier, speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer-Ingelheim, Bristol-Myers-Squibb, Lilly, Merck, Novartis, Novo-Nordisk, Pfizer, Regeneron, Sanofi, Servier, outside the submitted work. RM has received institutional research grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers-Squibb, CSL Behring, Eli Lilly/Daiichi-Sankyo, Medtronic, Novartis Pharmaceuticals, OrbusNeich; has served as a consultant for Abbott Vascular, American College of Cardiology, AstraZeneca, Boston Scientific, CardioKinetix, CSL Behring, Medscape, Shanghai Bracco Sine Pharmaceutical, Spectranetics; has served on the advisory board for Bristol Myers-Squibb; has received institutional advisory board funding from Bristol-Myers Squibb; has received institutional funding from Claret Medical; owns equity in Claret Medical and Elixir Medical; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical; has served on the data safety monitoring board for Watermark Research Partners; and has a spouse who has served as a consultant for Abiomed and The Medicines Company.

Publisher Copyright:
© 2018

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.amjcard.2018.07.041

Cite this

Sorrentino, S., Giustino, G., Baber, U., Sartori, S., Cohen, D. J., Henry, T. D., Farhan, S., Sharma, M., Ariti, C., Dangas, G., Gibson, M., Faggioni, M., Krucoff, M. W., Aquino, M., Chandrasekhar, J., Moliterno, D. J., Colombo, A., Vogel, B., Chieffo, A., ... Mehran, R. (2018). Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry). American Journal of Cardiology, 122(10), 1638-1646. https://doi.org/10.1016/j.amjcard.2018.07.041

@article{68b6140899a64ac6b60f7de93774fb26,

title = "Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)",

abstract = "The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (pinteraction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.",

author = "Sabato Sorrentino and Gennaro Giustino and Usman Baber and Samantha Sartori and Cohen, {David J.} and Henry, {Timothy D.} and Serdar Farhan and Madhav Sharma and Cono Ariti and George Dangas and Michael Gibson and Michela Faggioni and Krucoff, {Mitchell W.} and Melissa Aquino and Jaya Chandrasekhar and Moliterno, {David J.} and Antonio Colombo and Birgit Vogel and Alaide Chieffo and Kini, {Annapoorna S.} and Bernhard Witzenbichler and Giora Weisz and Steg, {Philippe Gabriel} and Stuart Pocock and Roxana Mehran",

note = "Funding Information: DC has received research grant support from Eli Lilly and Astra Zeneca, consulting fees from Eli Lilly, Astra Zeneca, and speaking honoraria from Astra Zeneca. TH has received research grant support from Eli Lilly & Company and Daiichi-Sankyo. GD has received consulting fees and honoraria from Johnson & Johnson, Sanofi, Covidien, The Medicines Company, Merck, CSL Behring, AstraZeneca, Medtronic, Abbott, Bayer, Boston Scientific, Osprey Medical, and GE Healthcare; and research grant support from Sanofi, Bristol-Myers Squibb, and Eli Lilly & Company/Daiichi-Sankyo. MG has received research grant support from Angel Medical Corporation, Atrium Medical Systems, Bayer Corporation, Ikaria, Janssen/Johnson & Johnson Corporation, Lantheus Medical Imaging, Merck & Company, Portola Pharmaceuticals, Roche Diagnostics, Sanofi, Stealth Peptides, St. Jude Medical, Volcano Corporation, and Walk Vascular; consulting fees from AstraZeneca, Baxter Healthcare, Bayer Corporation, CRF, Consensus Medical Communications, CSL Behring, Cytori Therapeutics, Eli Lilly & Company/Daiichi Sankyo, Exeter Group, Genentech, GlaxoSmithKline, Janssen/Johnson & Johnson Corporation, Ortho McNeil, St. Jude Medical, and The Medicines Company; and royalty fees from UpToDate in Cardiovascular Medicine. DJM has received institutional research grant support from AstraZeneca. MK has received consulting fees from Abbott Vascular, Abbott laboratories, OrbusNeich, Angelmed, Volcano, Biosensors, Svelte, OrbusNeich, Medtronic, and Terumo; and research grant support from Abbott, Terumo, Angelmed, Ikaria, OrbusNeich, Cardiovascular Systems, Inc. (CSI), Eli Lilly & Company and Medtronic. AC has received consulting fees and honoraria from Carbostent and Implantable Devices (CID); and other fees from Direct Flow Medical. AK serves on the speaker's bureau of the American College of Cardiology; and has received consulting fees from WebMD. PGS discloses the following relation: research grant from Bayer, Merck, Sanofi, and Servier, speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer-Ingelheim, Bristol-Myers-Squibb, Lilly, Merck, Novartis, Novo-Nordisk, Pfizer, Regeneron, Sanofi, Servier, outside the submitted work. RM has received institutional research grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers-Squibb, CSL Behring, Eli Lilly/Daiichi-Sankyo, Medtronic, Novartis Pharmaceuticals, OrbusNeich; has served as a consultant for Abbott Vascular, American College of Cardiology, AstraZeneca, Boston Scientific, CardioKinetix, CSL Behring, Medscape, Shanghai Bracco Sine Pharmaceutical, Spectranetics; has served on the advisory board for Bristol Myers-Squibb; has received institutional advisory board funding from Bristol-Myers Squibb; has received institutional funding from Claret Medical; owns equity in Claret Medical and Elixir Medical; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical; has served on the data safety monitoring board for Watermark Research Partners; and has a spouse who has served as a consultant for Abiomed and The Medicines Company. Publisher Copyright: {\textcopyright} 2018",

year = "2018",

month = nov,

day = "15",

doi = "10.1016/j.amjcard.2018.07.041",

language = "English",

volume = "122",

pages = "1638--1646",

number = "10",

}

Sorrentino, S, Giustino, G, Baber, U, Sartori, S, Cohen, DJ, Henry, TD, Farhan, S, Sharma, M, Ariti, C, Dangas, G, Gibson, M, Faggioni, M, Krucoff, MW, Aquino, M, Chandrasekhar, J, Moliterno, DJ, Colombo, A, Vogel, B, Chieffo, A, Kini, AS, Witzenbichler, B, Weisz, G, Steg, PG, Pocock, S & Mehran, R 2018, 'Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)', American Journal of Cardiology, vol. 122, no. 10, pp. 1638-1646. https://doi.org/10.1016/j.amjcard.2018.07.041

Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry). / Sorrentino, Sabato; Giustino, Gennaro; Baber, Usman et al.
In: American Journal of Cardiology, Vol. 122, No. 10, 15.11.2018, p. 1638-1646.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)

AU - Sorrentino, Sabato

AU - Giustino, Gennaro

AU - Baber, Usman

AU - Sartori, Samantha

AU - Cohen, David J.

AU - Henry, Timothy D.

AU - Farhan, Serdar

AU - Sharma, Madhav

AU - Ariti, Cono

AU - Dangas, George

AU - Gibson, Michael

AU - Faggioni, Michela

AU - Krucoff, Mitchell W.

AU - Aquino, Melissa

AU - Chandrasekhar, Jaya

AU - Moliterno, David J.

AU - Colombo, Antonio

AU - Vogel, Birgit

AU - Chieffo, Alaide

AU - Kini, Annapoorna S.

AU - Witzenbichler, Bernhard

AU - Weisz, Giora

AU - Steg, Philippe Gabriel

AU - Pocock, Stuart

AU - Mehran, Roxana

N1 - Funding Information: DC has received research grant support from Eli Lilly and Astra Zeneca, consulting fees from Eli Lilly, Astra Zeneca, and speaking honoraria from Astra Zeneca. TH has received research grant support from Eli Lilly & Company and Daiichi-Sankyo. GD has received consulting fees and honoraria from Johnson & Johnson, Sanofi, Covidien, The Medicines Company, Merck, CSL Behring, AstraZeneca, Medtronic, Abbott, Bayer, Boston Scientific, Osprey Medical, and GE Healthcare; and research grant support from Sanofi, Bristol-Myers Squibb, and Eli Lilly & Company/Daiichi-Sankyo. MG has received research grant support from Angel Medical Corporation, Atrium Medical Systems, Bayer Corporation, Ikaria, Janssen/Johnson & Johnson Corporation, Lantheus Medical Imaging, Merck & Company, Portola Pharmaceuticals, Roche Diagnostics, Sanofi, Stealth Peptides, St. Jude Medical, Volcano Corporation, and Walk Vascular; consulting fees from AstraZeneca, Baxter Healthcare, Bayer Corporation, CRF, Consensus Medical Communications, CSL Behring, Cytori Therapeutics, Eli Lilly & Company/Daiichi Sankyo, Exeter Group, Genentech, GlaxoSmithKline, Janssen/Johnson & Johnson Corporation, Ortho McNeil, St. Jude Medical, and The Medicines Company; and royalty fees from UpToDate in Cardiovascular Medicine. DJM has received institutional research grant support from AstraZeneca. MK has received consulting fees from Abbott Vascular, Abbott laboratories, OrbusNeich, Angelmed, Volcano, Biosensors, Svelte, OrbusNeich, Medtronic, and Terumo; and research grant support from Abbott, Terumo, Angelmed, Ikaria, OrbusNeich, Cardiovascular Systems, Inc. (CSI), Eli Lilly & Company and Medtronic. AC has received consulting fees and honoraria from Carbostent and Implantable Devices (CID); and other fees from Direct Flow Medical. AK serves on the speaker's bureau of the American College of Cardiology; and has received consulting fees from WebMD. PGS discloses the following relation: research grant from Bayer, Merck, Sanofi, and Servier, speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer-Ingelheim, Bristol-Myers-Squibb, Lilly, Merck, Novartis, Novo-Nordisk, Pfizer, Regeneron, Sanofi, Servier, outside the submitted work. RM has received institutional research grant support from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol Myers-Squibb, CSL Behring, Eli Lilly/Daiichi-Sankyo, Medtronic, Novartis Pharmaceuticals, OrbusNeich; has served as a consultant for Abbott Vascular, American College of Cardiology, AstraZeneca, Boston Scientific, CardioKinetix, CSL Behring, Medscape, Shanghai Bracco Sine Pharmaceutical, Spectranetics; has served on the advisory board for Bristol Myers-Squibb; has received institutional advisory board funding from Bristol-Myers Squibb; has received institutional funding from Claret Medical; owns equity in Claret Medical and Elixir Medical; has served on the executive committee for Janssen Pharmaceuticals and Osprey Medical; has served on the data safety monitoring board for Watermark Research Partners; and has a spouse who has served as a consultant for Abiomed and The Medicines Company. Publisher Copyright: © 2018

PY - 2018/11/15

Y1 - 2018/11/15

N2 - The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (pinteraction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.

AB - The impact of dual antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention with drug eluting stent implantation in patients at high atherothrombotic risk remains unclear. We aimed to characterize the risk for adverse events, and its relation with the mode of DAPT cessation in patients at high atherothrombotic risk (HATR). Considering patients treated with drug-eluting stents among those enrolled in the Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients registry, we defined subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR). DAPT cessation-modes were defined as physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance. Compared to patients with LATR (n = 2867; 68.2%), patients with HATR (n = 1340; 31.8%) were older with a higher prevalence of cardiovascular risk factors. Over 2 years, HATR patients had lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p = 0.002) and trend for disruption (11.5% vs 13.7%, p = 0.051), though no significant difference in the rate of DAPT interruption. Patients with HATR had higher 2-year rates of cardiac death, MI, or stent thrombosis compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001). Disruption of DAPT was associated with greater risk for cardiac death, MI, or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 to 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 to 4.80) patients (pinteraction = 0.40). The degree of atherothrombotic risk influences the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Atherothrombotic risk status does not influence the association between DAPT cessation and cardiac risk.

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Dual Antiplatelet Therapy Cessation and Adverse Events After Drug-Eluting Stent Implantation in Patients at High Risk for Atherothrombosis (from the PARIS Registry)

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