TY - JOUR
T1 - 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)
AU - Baber, Usman
AU - Li, Shawn X.
AU - Pinnelas, Rebecca
AU - Pocock, Stuart J.
AU - Krucoff, Mitchell W.
AU - Ariti, Cono
AU - Michael Gibson, C.
AU - Gabriel Steg, Philippe
AU - Weisz, Giora
AU - Witzenbichler, Bernhard
AU - Henry, Timothy D.
AU - Kini, Annapoorna S.
AU - Stuckey, Thomas
AU - Cohen, David J.
AU - Iakovou, Ioannis
AU - Dangas, George
AU - Aquino, Melissa B.
AU - Sartori, Samantha
AU - Chieffo, Alaide
AU - Moliterno, David J.
AU - Colombo, Antonio
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2018 American Heart Association, Inc.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - 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. (Circ Cardiovasc Interv. 2018;11:e006144. DOI: 10.1161/CIRCINTERVENTIONS.117.006144.)
AB - 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. (Circ Cardiovasc Interv. 2018;11:e006144. DOI: 10.1161/CIRCINTERVENTIONS.117.006144.)
KW - Blood platelets
KW - Chronic
KW - Follow-up studies
KW - Hemorrhage
KW - Percutaneous coronary intervention
KW - Renal insufficiency
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U2 - 10.1161/CIRCINTERVENTIONS.117.006144
DO - 10.1161/CIRCINTERVENTIONS.117.006144
M3 - Article
C2 - 29870385
AN - SCOPUS:85053433467
SN - 1941-7640
VL - 11
JO - Circulation: Cardiovascular Interventions
JF - Circulation: Cardiovascular Interventions
IS - 3
M1 - e006144
ER -