TY - JOUR
T1 - Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age
T2 - Analysis From the PARIS Registry
AU - Joyce, Lauren C.
AU - Baber, Usman
AU - Claessen, Bimmer E.
AU - Sartori, Samantha
AU - Chandrasekhar, Jaya
AU - Cohen, David J.
AU - Henry, Timothy D.
AU - Ariti, Cono
AU - Dangas, George
AU - Faggioni, Michela
AU - Aoi, Shunsuke
AU - Gibson, C. Michael
AU - Aquino, Melissa
AU - Krucoff, Mitchell W.
AU - Vogel, Birgit
AU - Moliterno, David J.
AU - Sorrentino, Sabato
AU - Colombo, Antonio
AU - Chieffo, Alaide
AU - Kini, Annapoorna
AU - Guedeney, Paul
AU - Witzenbichler, Bernhard
AU - Weisz, Giora
AU - Steg, Philippe Gabriel
AU - Pocock, Stuart
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2019 American College of Cardiology Foundation
PY - 2019/5/27
Y1 - 2019/5/27
N2 - Objectives: The aim of this study was to examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention in relation to age. Background: Examination of outcomes by age after percutaneous coronary intervention is relevant given the aging population. Methods: Two-year clinical outcomes, incidence, and effect of DAPT cessation on outcomes were compared by ages ≤55, 56 to 74, and ≥75 years from the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) registry. DAPT cessation included physician-recommended discontinuation, interruption for surgery, and disruption (from noncompliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a secondary restrictive definition of MACE (MACE2) excluding target lesion revascularization, and bleeding. Results: A total of 1,192 patients (24%) were ≤55 years, 2,869 (57%) were 56 to 74 years, and 957 (19%) were ≥75 years of age. Patients ≥75 years of age had higher DAPT cessation rates and increased risk for MACE2, death, cardiac death, and bleeding compared with younger patients. Discontinuation and interruption were not associated with increased cardiovascular risk across age groups, whereas disruption was associated with increased risk for MACE and MACE2 in younger patients but not in patients ≥75 years of age (p for trend <0.05). Conclusions: Nonadherence and outcomes vary by age, with patients ≥75 years having the highest DAPT cessation rates. We observed no association between outcomes and DAPT cessation in patients ≥75 years, whereas discontinuation was associated with lower MACE rates and disruption with increased MACE rates in patients <75 years.
AB - Objectives: The aim of this study was to examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention in relation to age. Background: Examination of outcomes by age after percutaneous coronary intervention is relevant given the aging population. Methods: Two-year clinical outcomes, incidence, and effect of DAPT cessation on outcomes were compared by ages ≤55, 56 to 74, and ≥75 years from the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) registry. DAPT cessation included physician-recommended discontinuation, interruption for surgery, and disruption (from noncompliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a secondary restrictive definition of MACE (MACE2) excluding target lesion revascularization, and bleeding. Results: A total of 1,192 patients (24%) were ≤55 years, 2,869 (57%) were 56 to 74 years, and 957 (19%) were ≥75 years of age. Patients ≥75 years of age had higher DAPT cessation rates and increased risk for MACE2, death, cardiac death, and bleeding compared with younger patients. Discontinuation and interruption were not associated with increased cardiovascular risk across age groups, whereas disruption was associated with increased risk for MACE and MACE2 in younger patients but not in patients ≥75 years of age (p for trend <0.05). Conclusions: Nonadherence and outcomes vary by age, with patients ≥75 years having the highest DAPT cessation rates. We observed no association between outcomes and DAPT cessation in patients ≥75 years, whereas discontinuation was associated with lower MACE rates and disruption with increased MACE rates in patients <75 years.
KW - age
KW - dual-antiplatelet therapy
KW - percutaneous coronary intervention
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U2 - 10.1016/j.jcin.2019.02.033
DO - 10.1016/j.jcin.2019.02.033
M3 - Article
C2 - 31122354
AN - SCOPUS:85065614790
SN - 1936-8798
VL - 12
SP - 983
EP - 992
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 10
ER -