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

Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Matthew Tomey, Mitchell Kruckoff, David Moliterno, Timothy D. Henry, Giora Weisz, C. Michael Gibson, Ioannis Iakovou, Annapoorna Kini, Michela Faggioni, Birgit Vogel, Serdar Farhan, Antonio Colombo, P. Gabriel Steg, Bernhard Witzenbichler, Alaide Chieffo, David CohenThomas Stuckey, Cono Ariti, Stuart Pocock, George Dangas, Roxana Mehran

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)132-139
Number of pages8
JournalInternational Journal of Cardiology
Volume243
DOIs
StatePublished - Sep 15 2017

Keywords

  • Drug eluting stents
  • Dual antiplatelet therapy cessation
  • Left main or proximal LAD
  • Major adverse cardiac events
  • Percutaneous coronary intervention

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