1. Incidence, predictors, and outcomes of DAPT disruption due to non-compliance vs. bleeding after PCI: insights from the PARIS Registry
- Author
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George Dangas, David Moliterno, Roxana Mehran, Alaide Chieffo, Kamilia Moalem, Stuart J. Pocock, Samantha Sartori, Bimmer E. Claessen, Antonio Colombo, Mitchell W. Krucoff, Usman Baber, Michael C. Gibson, Ioannis Iakovou, A. Kini, Bernhard Witzenbichler, Melissa Aquino, and Jaya Chandrasekhar
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hemorrhage ,030204 cardiovascular system & hematology ,Lower risk ,Risk Assessment ,Drug Administration Schedule ,Medication Adherence ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Registries ,030212 general & internal medicine ,Myocardial infarction ,Prospective cohort study ,Aged ,Aspirin ,business.industry ,Incidence ,Warfarin ,Percutaneous coronary intervention ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Purinergic P2Y Receptor Antagonists ,Cardiology ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,business ,Platelet Aggregation Inhibitors ,Mace ,medicine.drug - Abstract
The disruption of dual antiplatelet therapy (DAPT) due to non-compliance or bleeding is known to significantly increase the risk of adverse outcomes after percutaneous coronary intervention (PCI). However, it is currently unknown if there are differences in the predictors and clinical impact of disruption due to non-compliance compared with bleeding. The patterns of non-adherence to antiplatelet regimens in stented patients (PARIS) registry was an international, multicenter prospective study of PCI patients discharged on DAPT (aspirin + a P2Y12 receptor). We analyzed the incidence, patient characteristics, predictors, and outcomes in patients with DAPT disruption due to non-compliance as compared to DAPT disruption due to bleeding in the PARIS registry. Predictors of non-recommended disruption and bleeding disruption were assessed using logistic regression. Risks associated with disruption on major adverse cardiac events (MACE, a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, and target lesion revascularization) were analyzed using time-updated Cox regression over 2-year follow-up. Out of 5018 patients, the rate of non-compliant DAPT disruption was 1.6% at 30 days (n = 79), 6.5% at 12 months (n = 328), and 9.1% at 2 years from PCI (n = 457). The rate of bleeding DAPT disruption was 0.6% at 30 days (n = 32), 3.1% at 12 months (n = 156), and 4.6% at 2 years (n = 229). Multivariate predictors of non-compliant disruption included female gender, history of smoking, acute coronary syndrome, and US patients which were associated with greater risk; and dyslipidemia and discharge PPI which were associated with lower risk. Multivariate predictors of bleeding disruption included older age, prior MI, and discharge warfarin which were associated with greater risk; and US region and intervention to the LAD which were associated with lower risk. Non-compliant disruption was associated with a significantly greater risk for MACE (HR 1.73, 95% CI 1.17–2.54, p = 0.006) and spontaneous myocardial infarction (HR 2.93, 95% CI 1.85–4.65, p
- Published
- 2019