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

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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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Percutaneous Coronary Intervention
Registries
Arteries
Therapeutics
Stents
Physicians
Acute Coronary Syndrome
Comorbidity
Thrombosis
Myocardial Infarction
Hemorrhage

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

In: International Journal of Cardiology, Vol. 243, No. 4, 2017, p. 132-139.

Research output: Contribution to journalArticle

Chandrasekhar, J, Baber, U, Sartori, S, Aquino, M, Tomey, M, Kruckoff, M, Moliterno, DJ, Henry, TD, Weisz, G, Gibson, CM, Iakovou, I, Kini, A, Faggioni, M, Vogel, B, Farhan, S, Colombo, A, Steg, PG, Witzenbichler, B, Chieffo, A, Cohen, D, Stuckey, T, Ariti, C, Pocock, S, Dangas, G & 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, vol. 243, no. 4, pp. 132-139. https://doi.org/10.1016/j.ijcard.2017.05.049
Chandrasekhar, J ; Baber, U ; Sartori, S ; Aquino, Melissa ; Tomey, M ; Kruckoff, M ; Moliterno, David J. ; Henry, TD ; Weisz, G ; Gibson, CM ; Iakovou, I ; Kini, A ; Faggioni, Michela ; Vogel, B ; Farhan, S ; Colombo, A ; Steg, PG ; Witzenbichler, B ; Chieffo, A ; Cohen, D ; Stuckey, T ; Ariti, C ; Pocock, S ; Dangas, G ; Mehran, R. / 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. In: International Journal of Cardiology. 2017 ; Vol. 243, No. 4. pp. 132-139.
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title = "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",
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 {\circledC} 2017 Elsevier B.V. All rights reserved.",
author = "J Chandrasekhar and U Baber and S Sartori and Melissa Aquino and M Tomey and M Kruckoff and Moliterno, {David J.} and TD Henry and G Weisz and CM Gibson and I Iakovou and A Kini and Michela Faggioni and B Vogel and S Farhan and A Colombo and PG Steg and B Witzenbichler and A Chieffo and D Cohen and T Stuckey and C Ariti and S Pocock and G Dangas and R Mehran",
year = "2017",
doi = "10.1016/j.ijcard.2017.05.049",
language = "English",
volume = "243",
pages = "132--139",
journal = "International Journal of Cardiology",
issn = "0167-5273",
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TY - JOUR

T1 - 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

AU - Chandrasekhar, J

AU - Baber, U

AU - Sartori, S

AU - Aquino, Melissa

AU - Tomey, M

AU - Kruckoff, M

AU - Moliterno, David J.

AU - Henry, TD

AU - Weisz, G

AU - Gibson, CM

AU - Iakovou, I

AU - Kini, A

AU - Faggioni, Michela

AU - Vogel, B

AU - Farhan, S

AU - Colombo, A

AU - Steg, PG

AU - Witzenbichler, B

AU - Chieffo, A

AU - Cohen, D

AU - Stuckey, T

AU - Ariti, C

AU - Pocock, S

AU - Dangas, G

AU - Mehran, R

PY - 2017

Y1 - 2017

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. Copyright © 2017 Elsevier B.V. All rights reserved.

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. Copyright © 2017 Elsevier B.V. All rights reserved.

U2 - 10.1016/j.ijcard.2017.05.049

DO - 10.1016/j.ijcard.2017.05.049

M3 - Article

VL - 243

SP - 132

EP - 139

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 4

ER -