TY - JOUR
T1 - Patterns and associations between DAPT cessation and 2-year clinical outcomes in left main/proximal LAD versus other PCI
T2 - Results from the Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients (PARIS) registry
AU - Chandrasekhar, Jaya
AU - Baber, Usman
AU - Sartori, Samantha
AU - Aquino, Melissa
AU - Tomey, Matthew
AU - Kruckoff, Mitchell
AU - Moliterno, David
AU - Henry, Timothy D.
AU - Weisz, Giora
AU - Gibson, C. Michael
AU - Iakovou, Ioannis
AU - Kini, Annapoorna
AU - Faggioni, Michela
AU - Vogel, Birgit
AU - Farhan, Serdar
AU - Colombo, Antonio
AU - Steg, P. Gabriel
AU - Witzenbichler, Bernhard
AU - Chieffo, Alaide
AU - Cohen, David
AU - Stuckey, Thomas
AU - Ariti, Cono
AU - Pocock, Stuart
AU - Dangas, George
AU - Mehran, Roxana
N1 - Publisher Copyright:
© 2017 Elsevier B.V.
PY - 2017/9/15
Y1 - 2017/9/15
N2 - Objectives Percutaneous coronary intervention (PCI) of the left main (LM) or proximal left anterior descending artery (pLAD) is considered high-risk as these segments subtend substantial left ventricular myocardial area. We assessed the patterns and associations between dual antiplatelet therapy (DAPT) cessation and 2-year outcomes in LM/pLAD vs. other PCI from the all-comer PARIS registry. Methods Two-year major adverse cardiovascular events (MACE) were a composite of cardiac death, myocardial infarction, definite/probable stent thrombosis or target lesion revascularization. DAPT cessation was predefined as physician-guided permanent discontinuation, temporary interruption, or non-recommended disruption due to non-compliance or bleeding. Results Of the study population (n = 5018), 25.0% (n = 1252) underwent LM/pLAD PCI and 75.0% (n = 3766) PCI to other segments. Compared to others, LM/pLAD patients presented with fewer comorbidities, less frequent acute coronary syndromes but more multivessel and bifurcation disease treated with greater stent lengths. Two-year adjusted risk of MACE (11.4% vs. 11.6%; HR 1.10, 95% CI 0.90–1.34, p = 0.36) was similar between LM/pLAD vs. other patients. DAPT discontinuation was significantly higher (43.3% vs. 39.4%, p = 0.01) in LM/pLAD patients with borderline significance for lower disruption (10.0% vs. 14.7%, p = 0.059) compared to other patients. DAPT discontinuation was not associated with higher risk of MACE in LM/pLAD (HR 0.65, 95% CI 0.34–1.25) or other PCI groups (HR 0.67, 95% CI 0.47–0.95). Conclusions LM/pLAD PCI was not an independent predictor of 2-year MACE. Compared to other PCI, patients undergoing LM/pLAD PCI had higher rates of physician recommended DAPT discontinuation, however, discontinuation did not result in greater adverse events.
AB - Objectives Percutaneous coronary intervention (PCI) of the left main (LM) or proximal left anterior descending artery (pLAD) is considered high-risk as these segments subtend substantial left ventricular myocardial area. We assessed the patterns and associations between dual antiplatelet therapy (DAPT) cessation and 2-year outcomes in LM/pLAD vs. other PCI from the all-comer PARIS registry. Methods Two-year major adverse cardiovascular events (MACE) were a composite of cardiac death, myocardial infarction, definite/probable stent thrombosis or target lesion revascularization. DAPT cessation was predefined as physician-guided permanent discontinuation, temporary interruption, or non-recommended disruption due to non-compliance or bleeding. Results Of the study population (n = 5018), 25.0% (n = 1252) underwent LM/pLAD PCI and 75.0% (n = 3766) PCI to other segments. Compared to others, LM/pLAD patients presented with fewer comorbidities, less frequent acute coronary syndromes but more multivessel and bifurcation disease treated with greater stent lengths. Two-year adjusted risk of MACE (11.4% vs. 11.6%; HR 1.10, 95% CI 0.90–1.34, p = 0.36) was similar between LM/pLAD vs. other patients. DAPT discontinuation was significantly higher (43.3% vs. 39.4%, p = 0.01) in LM/pLAD patients with borderline significance for lower disruption (10.0% vs. 14.7%, p = 0.059) compared to other patients. DAPT discontinuation was not associated with higher risk of MACE in LM/pLAD (HR 0.65, 95% CI 0.34–1.25) or other PCI groups (HR 0.67, 95% CI 0.47–0.95). Conclusions LM/pLAD PCI was not an independent predictor of 2-year MACE. Compared to other PCI, patients undergoing LM/pLAD PCI had higher rates of physician recommended DAPT discontinuation, however, discontinuation did not result in greater adverse events.
KW - Drug eluting stents
KW - Dual antiplatelet therapy cessation
KW - Left main or proximal LAD
KW - Major adverse cardiac events
KW - Percutaneous coronary intervention
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U2 - 10.1016/j.ijcard.2017.05.049
DO - 10.1016/j.ijcard.2017.05.049
M3 - Article
C2 - 28554669
AN - SCOPUS:85019662959
SN - 0167-5273
VL - 243
SP - 132
EP - 139
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -