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Int J Cardiol. 2017 Sep 15;243:132-139. doi: 10.1016/j.ijcard.2017.05.049. Epub 2017 May 12.

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.

Author information

1
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
2
Duke University School of Medicine, Durham, NC, USA.
3
University of Kentucky, Lexington, KY, USA.
4
Cedars-Sinai Medical Center, Los Angeles, USA.
5
Shaare Zedek Medical Center, Jerusalem, Israel.
6
Harvard Medical School, Cambridge, MA, United States.
7
Onassis Cardiac Surgery Centre, Athens, Greece.
8
San Raffaele Hospital, Milan, Italy.
9
Hôpital Bichat-Claude Bernard, Paris, France.
10
Helios Amper-Klinikum, Dachau, Germany.
11
St Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO, USA.
12
Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, NC, USA.
13
London School of Hygiene and Tropical Medicine, London, United Kingdom.
14
Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: roxana.mehran@mountsinai.org.

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.

KEYWORDS:

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

PMID:
28554669
DOI:
10.1016/j.ijcard.2017.05.049
[Indexed for MEDLINE]

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