Patterns and Impact of Dual Antiplatelet Cessation on Cardiovascular Risk After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes

Mikkel Schoos, David Power, Usman Baber, Samantha Sartori, Bimmer Claessen, Anton Camaj, Philippe Steg, Cono Ariti, Giora Weisz, Bernhard Witzenbichler, Timothy Henry, David Cohen, David Antoniucci, Mitchell Krucoff, James Hermiller, Charles Gibson, Alaide Chieffo, David Moliterno, Antonio Colombo, Stuart PocockGeorge Dangas, Roxana Mehran

Research output: Contribution to journalArticle

Abstract

The aim of this study was to examine the patterns and clinical impact of differing modes of dual-antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention (PCI) in patients presenting with and without acute coronary syndromes (ACS). The PARIS (patterns of nonadherence to antiplatelet regimens in stented patients) registry was a multicenter study of 5,018 patients who underwent PCI. DAPT cessation was categorized as physician-recommended discontinuation, interruption, or disruption. Overall rates of 2-year DAPT discontinuation did not differ between non-ACS and ACS patients (38.8% vs 37.2%, p = 0.252). ACS patients were less likely to interrupt DAPT (8.5% vs 10.7% p<0.001), but were more likely to disrupt DAPT (16.4% vs 11.9%, p<0001). Adverse events after DAPT cessation were highest after disruption, intermediate with discontinuation, and lowest with interruption across both groups. Disruption of DAPT predicted MACE in both ACS patients (hazard ratio [HR] 2.89 [1.88 to 4.45; p<0.001]) and non-ACS patients (HR 2.08 [1.29 to 3.35; p = 0.002]). Interruption of DAPT predicated MACE in ACS patients (HR 2.72 [1.35 to 5.48]) but not in non-ACS patients (HR 0.44 [0.14 to 1.40]; p interaction ≤0.01). In conclusion, the incidence of DAPT cessation mode differs by presentation with or without ACS. Physician guided DAPT discontinuation was the most common mode of DAPT cessation and appears to be safe across both groups. There were higher rates of adverse events associated with the interruption of DAPT in ACS patients.

Original languageEnglish
Pages (from-to)709-716
Number of pages8
JournalAmerican Journal of Cardiology
Volume123
Issue number5
DOIs
Publication statusPublished - Mar 1 2019

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Schoos, M., Power, D., Baber, U., Sartori, S., Claessen, B., Camaj, A., Steg, P., Ariti, C., Weisz, G., Witzenbichler, B., Henry, T., Cohen, D., Antoniucci, D., Krucoff, M., Hermiller, J., Gibson, C., Chieffo, A., Moliterno, D., Colombo, A., ... Mehran, R. (2019). Patterns and Impact of Dual Antiplatelet Cessation on Cardiovascular Risk After Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes. American Journal of Cardiology, 123(5), 709-716. https://doi.org/10.1016/j.amjcard.2018.11.051