Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age: Analysis From the PARIS Registry

Lauren C. Joyce, Usman Baber, Bimmer E. Claessen, Samantha Sartori, Jaya Chandrasekhar, David J. Cohen, Timothy D. Henry, Cono Ariti, George Dangas, Michela Faggioni, Shunsuke Aoi, C. Michael Gibson, Melissa Aquino, Mitchell W. Krucoff, Birgit Vogel, David J. Moliterno, Sabato Sorrentino, Antonio Colombo, Alaide Chieffo, Annapoorna KiniPaul Guedeney, Bernhard Witzenbichler, Giora Weisz, Philippe Gabriel Steg, Stuart Pocock, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


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.

Original languageEnglish
Pages (from-to)983-992
Number of pages10
JournalJACC: Cardiovascular Interventions
Issue number10
StatePublished - May 27 2019

Bibliographical note

Publisher Copyright:
© 2019 American College of Cardiology Foundation


  • age
  • dual-antiplatelet therapy
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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