TY - JOUR
T1 - Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes
T2 - Insights from the PARIS Registry
AU - Vogel, Birgit
AU - Chandrasekhar, Jaya
AU - Baber, Usman
AU - Mastoris, Ioannis
AU - Sartori, Samantha
AU - Aquino, Melissa
AU - Krucoff, Mitchell W.
AU - Moliterno, David J.
AU - Henry, Timothy D.
AU - Weisz, Giora
AU - Gibson, C. Michael
AU - Iakovou, Ioannis
AU - Kini, Annapoorna S.
AU - Farhan, Serdar
AU - Sorrentino, Sabato
AU - Faggioni, Michela
AU - Colombo, Antonio
AU - Steg, Philippe Gabriel
AU - Witzenbichler, Bernhard
AU - Chieffo, Alaide
AU - Cohen, David J.
AU - Stuckey, Thomas
AU - Ariti, Cono
AU - Dangas, George D.
AU - Pocock, Stuart
AU - Mehran, Roxana
N1 - Funding Information:
The PARIS registry was supported by research grants from Bristol-Myers Squibb and Sanofi-Aventis.
Publisher Copyright:
© 2019 Georg Thieme Verlag KG Stuttgart - New York.
PY - 2019
Y1 - 2019
N2 - Background Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe. Methods Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization. Results Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65-1.01, p = 0.065). Conclusion DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.
AB - Background Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe. Methods Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization. Results Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65-1.01, p = 0.065). Conclusion DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.
KW - adherence
KW - dual antiplatelet therapy
KW - dual antiplatelet therapy cessation
KW - geographical differences
KW - percutaneous coronary intervention
UR - http://www.scopus.com/inward/record.url?scp=85072746168&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85072746168&partnerID=8YFLogxK
U2 - 10.1055/s-0039-1693463
DO - 10.1055/s-0039-1693463
M3 - Article
C2 - 31365942
AN - SCOPUS:85072746168
VL - 19
SP - 1704
EP - 1711
IS - 10
ER -