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
| Autor: | Timothy D. Henry, Antonio Colombo, Matthew I. Tomey, Michela Faggioni, Alaide Chieffo, Stuart J. Pocock, Jaya Chandrasekhar, George Dangas, Melissa Aquino, Serdar Farhan, Usman Baber, C. Michael Gibson, David J. Cohen, Bernhard Witzenbichler, P. Gabriel Steg, Roxana Mehran, Annapoorna Kini, Giora Weisz, Ioannis Iakovou, Thomas Stuckey, Samantha Sartori, Cono Ariti, Mitchell Kruckoff, Birgit Vogel, David J. Moliterno |
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| Přispěvatelé: | Chandrasekhar, Jaya, Baber, Usman, Sartori, Samantha, Aquino, Melissa, Tomey, Matthew, Kruckoff, Mitchell, Moliterno, David, Henry, Timothy D., Weisz, Giora, Gibson, C. Michael, Iakovou, Ioanni, Kini, Annapoorna, Faggioni, Michela, Vogel, Birgit, Farhan, Serdar, Colombo, Antonio, Steg, P. Gabriel, Witzenbichler, Bernhard, Chieffo, Alaide, Cohen, David, Stuckey, Thoma, Ariti, Cono, Pocock, Stuart, Dangas, George, Mehran, Roxana |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment 030204 cardiovascular system & hematology Left main or proximal LAD Medication Adherence Percutaneous coronary intervention 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Dual antiplatelet therapy cessation Internal medicine medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Prospective Studies Registries Drug eluting stent Adverse effect Aged business.industry Medicine (all) Stent Drug-Eluting Stents Middle Aged medicine.disease Coronary Vessels Discontinuation Surgery Death Treatment Outcome Cardiovascular Diseases Conventional PCI Cardiology Major adverse cardiac event Population study Drug Therapy Combination Female business Cardiology and Cardiovascular Medicine Mace Platelet Aggregation Inhibitors Follow-Up Studies |
| Popis: | 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 0.90â1.34, 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 0.34â1.25) or other PCI groups (HR 0.67, 95% CI 0.47â0.95). 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. |
| Databáze: | OpenAIRE |
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