Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry

Birgit Vogel; Jaya Chandrasekhar; Usman Baber; Ioannis Mastoris; Samantha Sartori; Melissa Aquino; Mitchell W. Krucoff; David J. Moliterno; Timothy D. Henry; Giora Weisz; C. Michael Gibson; Ioannis Iakovou; Annapoorna S. Kini; Serdar Farhan; Sabato Sorrentino; Michela Faggioni; Antonio Colombo; Philippe Gabriel Steg; Bernhard Witzenbichler; Alaide Chieffo; David J. Cohen; Thomas Stuckey; Cono Ariti; George D. Dangas; Stuart Pocock; Roxana Mehran

doi:10.1055/s-0039-1693463

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2019; 119(10): 1704-1711
DOI: 10.1055/s-0039-1693463

Atherosclerosis and Ischaemic Disease

Georg Thieme Verlag KG Stuttgart · New York

Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry

Birgit Vogel

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Jaya Chandrasekhar

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Usman Baber

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Ioannis Mastoris

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Samantha Sartori

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Melissa Aquino

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Mitchell W. Krucoff

²Duke University School of Medicine, Durham, North Carolina, United States

,

David J. Moliterno

³University of Kentucky, Lexington, Kentucky, United States

,

Timothy D. Henry

⁴The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, United States

,

Giora Weisz

⁵Montefiore Medical Center, New York, New York, United States

,

C. Michael Gibson

⁶Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States

,

Ioannis Iakovou

⁷Onassis Cardiac Surgery Centre, Athens, Greece

,

Annapoorna S. Kini

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Serdar Farhan

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Sabato Sorrentino

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Michela Faggioni

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Antonio Colombo

⁸San Raffaele Scientific Institute, Milan, Italy

,

Philippe Gabriel Steg

⁹Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France

,

Bernhard Witzenbichler

¹⁰Helios Amper-Klinikum, Dachau, Germany

,

Alaide Chieffo

⁸San Raffaele Scientific Institute, Milan, Italy

,

David J. Cohen

¹¹St. Luke's Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri, United States

,

Thomas Stuckey

¹²Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, United States

,

Cono Ariti

¹³London School of Hygiene and Tropical Medicine, London, United Kingdom

,

George D. Dangas

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

,

Stuart Pocock

¹³London School of Hygiene and Tropical Medicine, London, United Kingdom

,

Roxana Mehran

¹The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States

› Author Affiliations

Abstract

Background Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe.

Methods Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization.

Results Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65–1.01, p = 0.065).

Conclusion DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.

Keywords

dual antiplatelet therapy - percutaneous coronary intervention - dual antiplatelet therapy cessation - geographical differences - adherence

Full Text

References

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