Patterns and associations between DAPT cessation and 2-year clinical outcomes in left main/proximal LAD versus other PCI: Results from the Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients (PARIS) registry

J Chandrasekhar, U Baber, S Sartori, Melissa Aquino, M Tomey, M Kruckoff, David J. Moliterno, TD Henry, G Weisz, CM Gibson, I Iakovou, A Kini, Michela Faggioni, B Vogel, S Farhan, A Colombo, PG Steg, B Witzenbichler, A Chieffo, D CohenT Stuckey, C Ariti, S Pocock, G Dangas, R Mehran

Research output: Contribution to journalArticle

Abstract

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. Copyright © 2017 Elsevier B.V. All rights reserved.
Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalInternational Journal of Cardiology
Volume243
Issue number4
DOIs
Publication statusPublished - 2017

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    Chandrasekhar, J., Baber, U., Sartori, S., Aquino, M., Tomey, M., Kruckoff, M., Moliterno, D. J., Henry, TD., Weisz, G., Gibson, CM., Iakovou, I., Kini, A., Faggioni, M., Vogel, B., Farhan, S., Colombo, A., Steg, PG., Witzenbichler, B., Chieffo, A., ... Mehran, R. (2017). Patterns and associations between DAPT cessation and 2-year clinical outcomes in left main/proximal LAD versus other PCI: Results from the Patterns of Non-Adherence to Dual Antiplatelet Therapy in Stented Patients (PARIS) registry. International Journal of Cardiology, 243(4), 132-139. https://doi.org/10.1016/j.ijcard.2017.05.049