Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents

Jennifer Yu, Usman Baber, Ioannis Mastoris, George Dangas, Samantha Sartori, Gennaro Giustino, Jaya Chandrasekhar, Annapoorna S. Kini, Roxana Mehran, Alaide Chieffo, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Objectives The aim of this study was to compare the incidence and impact of cessation of dual-antiplatelet therapy (DAPT) in women and men treated with percutaneous coronary intervention. Background Nonadherence to cardiovascular medications and female sex are associated with worse outcomes. However, the patterns and impact of DAPT cessation in women compared with men following percutaneous coronary intervention have not been studied. Methods Baseline characteristics, patterns of DAPT cessation, and 2-year clinical outcomes were compared in 5,031 patients (1,279 women, 3,739 men) enrolled following successful percutaneous coronary intervention with stents in the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) study. DAPT cessation was adjudicated as physician-guided discontinuation, interruption for surgery, or disruption due to bleeding or noncompliance. Clinical endpoints were major adverse cardiac events (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a second restricted definition of major adverse cardiac events excluding target lesion revascularization, and bleeding. Results DAPT cessation was more common in women than men (59.1% vs. 55.9%, p = 0.007) and comprised increased rates of discontinuation, disruption for bleeding, and disruption due to noncompliance. The impact of DAPT cessation was similar regardless of sex and varied according the mode; in particular, disruption was associated with increased risk for both ischemic and bleeding events. After adjusting for differences in baseline and treatment characteristics as well as DAPT cessation events, female sex remained an independent predictor of bleeding but not of ischemic events. Conclusions DAPT cessation was more common in women, but its impact was similar in women and men. Female sex was an independent predictor of bleeding but not of ischemic events after adjustment for differences in DAPT cessation and baseline and treatment characteristics.
Original languageEnglish
Pages (from-to)1461 - 1469
Number of pages9
JournalJACC: Cardiovascular Interventions
Volume9
Issue number14
DOIs
Publication statusPublished - Jul 1 2016

Fingerprint

Percutaneous Coronary Intervention
Sex Characteristics
Stents
Hemorrhage
Therapeutics
Withholding Treatment
Thrombosis
Myocardial Infarction
Physicians
Incidence

Keywords

  • adherence
  • bleeding
  • compliance
  • dual-antiplatelet therapy
  • sex

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents. / Yu, Jennifer; Baber, Usman; Mastoris, Ioannis; Dangas, George; Sartori, Samantha; Giustino, Gennaro; Chandrasekhar, Jaya; Kini, Annapoorna S.; Mehran, Roxana; Chieffo, Alaide; Colombo, Antonio.

In: JACC: Cardiovascular Interventions, Vol. 9, No. 14, 01.07.2016, p. 1461 - 1469.

Research output: Contribution to journalArticle

Yu, J, Baber, U, Mastoris, I, Dangas, G, Sartori, S, Giustino, G, Chandrasekhar, J, Kini, AS, Mehran, R, Chieffo, A & Colombo, A 2016, 'Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents', JACC: Cardiovascular Interventions, vol. 9, no. 14, pp. 1461 - 1469. https://doi.org/10.1016/j.jcin.2016.04.004
Yu, Jennifer ; Baber, Usman ; Mastoris, Ioannis ; Dangas, George ; Sartori, Samantha ; Giustino, Gennaro ; Chandrasekhar, Jaya ; Kini, Annapoorna S. ; Mehran, Roxana ; Chieffo, Alaide ; Colombo, Antonio. / Sex-Based Differences in Cessation of Dual-Antiplatelet Therapy Following Percutaneous Coronary Intervention With Stents. In: JACC: Cardiovascular Interventions. 2016 ; Vol. 9, No. 14. pp. 1461 - 1469.
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abstract = "Objectives The aim of this study was to compare the incidence and impact of cessation of dual-antiplatelet therapy (DAPT) in women and men treated with percutaneous coronary intervention. Background Nonadherence to cardiovascular medications and female sex are associated with worse outcomes. However, the patterns and impact of DAPT cessation in women compared with men following percutaneous coronary intervention have not been studied. Methods Baseline characteristics, patterns of DAPT cessation, and 2-year clinical outcomes were compared in 5,031 patients (1,279 women, 3,739 men) enrolled following successful percutaneous coronary intervention with stents in the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) study. DAPT cessation was adjudicated as physician-guided discontinuation, interruption for surgery, or disruption due to bleeding or noncompliance. Clinical endpoints were major adverse cardiac events (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a second restricted definition of major adverse cardiac events excluding target lesion revascularization, and bleeding. Results DAPT cessation was more common in women than men (59.1{\%} vs. 55.9{\%}, p = 0.007) and comprised increased rates of discontinuation, disruption for bleeding, and disruption due to noncompliance. The impact of DAPT cessation was similar regardless of sex and varied according the mode; in particular, disruption was associated with increased risk for both ischemic and bleeding events. After adjusting for differences in baseline and treatment characteristics as well as DAPT cessation events, female sex remained an independent predictor of bleeding but not of ischemic events. Conclusions DAPT cessation was more common in women, but its impact was similar in women and men. Female sex was an independent predictor of bleeding but not of ischemic events after adjustment for differences in DAPT cessation and baseline and treatment characteristics.",
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AU - Dangas, George

AU - Sartori, Samantha

AU - Giustino, Gennaro

AU - Chandrasekhar, Jaya

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N2 - Objectives The aim of this study was to compare the incidence and impact of cessation of dual-antiplatelet therapy (DAPT) in women and men treated with percutaneous coronary intervention. Background Nonadherence to cardiovascular medications and female sex are associated with worse outcomes. However, the patterns and impact of DAPT cessation in women compared with men following percutaneous coronary intervention have not been studied. Methods Baseline characteristics, patterns of DAPT cessation, and 2-year clinical outcomes were compared in 5,031 patients (1,279 women, 3,739 men) enrolled following successful percutaneous coronary intervention with stents in the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) study. DAPT cessation was adjudicated as physician-guided discontinuation, interruption for surgery, or disruption due to bleeding or noncompliance. Clinical endpoints were major adverse cardiac events (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a second restricted definition of major adverse cardiac events excluding target lesion revascularization, and bleeding. Results DAPT cessation was more common in women than men (59.1% vs. 55.9%, p = 0.007) and comprised increased rates of discontinuation, disruption for bleeding, and disruption due to noncompliance. The impact of DAPT cessation was similar regardless of sex and varied according the mode; in particular, disruption was associated with increased risk for both ischemic and bleeding events. After adjusting for differences in baseline and treatment characteristics as well as DAPT cessation events, female sex remained an independent predictor of bleeding but not of ischemic events. Conclusions DAPT cessation was more common in women, but its impact was similar in women and men. Female sex was an independent predictor of bleeding but not of ischemic events after adjustment for differences in DAPT cessation and baseline and treatment characteristics.

AB - Objectives The aim of this study was to compare the incidence and impact of cessation of dual-antiplatelet therapy (DAPT) in women and men treated with percutaneous coronary intervention. Background Nonadherence to cardiovascular medications and female sex are associated with worse outcomes. However, the patterns and impact of DAPT cessation in women compared with men following percutaneous coronary intervention have not been studied. Methods Baseline characteristics, patterns of DAPT cessation, and 2-year clinical outcomes were compared in 5,031 patients (1,279 women, 3,739 men) enrolled following successful percutaneous coronary intervention with stents in the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) study. DAPT cessation was adjudicated as physician-guided discontinuation, interruption for surgery, or disruption due to bleeding or noncompliance. Clinical endpoints were major adverse cardiac events (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a second restricted definition of major adverse cardiac events excluding target lesion revascularization, and bleeding. Results DAPT cessation was more common in women than men (59.1% vs. 55.9%, p = 0.007) and comprised increased rates of discontinuation, disruption for bleeding, and disruption due to noncompliance. The impact of DAPT cessation was similar regardless of sex and varied according the mode; in particular, disruption was associated with increased risk for both ischemic and bleeding events. After adjusting for differences in baseline and treatment characteristics as well as DAPT cessation events, female sex remained an independent predictor of bleeding but not of ischemic events. Conclusions DAPT cessation was more common in women, but its impact was similar in women and men. Female sex was an independent predictor of bleeding but not of ischemic events after adjustment for differences in DAPT cessation and baseline and treatment characteristics.

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