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)

Usman Baber, Shawn X. Li, Rebecca Pinnelas, Stuart J. Pocock, Mitchell W. Krucoff, Cono Ariti, C. Michael Gibson, Philippe Gabriel Steg, Giora Weisz, Bernhard Witzenbichler, Timothy D. Henry, Annapoorna S. Kini, Thomas Stuckey, David J. Cohen, Ioannis Iakovou, George Dangas, Melissa B. Aquino, Samantha Sartori, Alaide Chieffo, David J. MoliternoAntonio Colombo, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

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.)

Original languageEnglish
Article numbere006144
JournalCirculation: Cardiovascular Interventions
Volume11
Issue number3
DOIs
StatePublished - Mar 1 2018

Bibliographical note

Publisher Copyright:
© 2018 American Heart Association, Inc.

Keywords

  • Blood platelets
  • Chronic
  • Follow-up studies
  • Hemorrhage
  • Percutaneous coronary intervention
  • Renal insufficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of '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)'. Together they form a unique fingerprint.

Cite this