Influence of Baseline Anemia on Dual Antiplatelet Therapy Cessation and Risk of Adverse Events After Percutaneous Coronary Intervention Insights From the PARIS Registry

被引:27
作者
Faggioni, Michela [1 ,2 ]
Baber, Usman [1 ]
Sartori, Samantha [1 ]
Chandrasekhar, Jaya [1 ]
Cohen, David J. [3 ]
Henry, Timothy D. [4 ]
Claessen, Bimmer E. [1 ]
Dangas, George D. [1 ]
Gibson, C. Michael [5 ]
Krucoff, Mitchell W. [6 ]
Vogel, Birgit [1 ]
Moliterno, David J. [7 ,8 ]
Sorrentino, Sabato [1 ]
Colombo, Antonio [1 ,9 ]
Chieffo, Alaide [9 ]
Kini, Annapoorna [1 ]
Farhan, Serdar [1 ]
Ariti, Cono [10 ]
Witzenbichler, Bernard [11 ]
Weisz, Giora [12 ,13 ]
Steg, Philippe Gabriel [14 ]
Pocock, Stuart [10 ]
Mehran, Roxana [1 ]
机构
[1] Icahn Sch Med Mt Sinai, Zena & Michael Wiener Cardiovasc Inst, Ctr Intervent Cardiovasc Res & Clin Trials, New York, NY 10029 USA
[2] James J Peters Vet Affairs Med Ctr, Dept Internal Med, Bronx, NY USA
[3] Univ Missouri, St Lukes Mid Amer Heart Inst, Sect Cardiovasc Dis, Dept Internal Med, Kansas City, MO 64110 USA
[4] Cedars Sinai Heart Inst, Div Cardiol, Los Angeles, CA USA
[5] Beth Israel Deaconess Med Ctr, Div Cardiol, Boston, MA 02215 USA
[6] Duke Univ, Sch Med, Dept Internal Med, Durham, NC USA
[7] Univ Kentucky, Gill Heart Inst, Lexington, KY 40506 USA
[8] Univ Kentucky, Div Cardiovasc Med, Lexington, KY 40506 USA
[9] Ist Sci San Raffaele, Cardiothorac Dept, Milan, Italy
[10] London Sch Hyg & Trop Med, Dept Med Stat, London, England
[11] Helios Amper Klinikum, Dept Cardiol & Pneumol, Dachau, Germany
[12] Cardiovasc Res Fdn, Clin Trials Ctr, New York, NY USA
[13] Montefiore Med Ctr, 111 E 210th St, Bronx, NY 10467 USA
[14] Univ Paris Diderot, AP HP, INSERM U1148, DHU,FIRE, Paris, France
关键词
anemia; bleeding events; compliance; DAPT cessation; dual antiplatelet therapy; BLEEDING RISK; IMPACT;
D O I
10.1161/CIRCINTERVENTIONS.118.007133
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Anemia is a well-recognized risk factor for both bleeding and ischemic events after percutaneous coronary intervention (PCI). We sought to determine the impact of baseline anemia on dual antiplatelet therapy (DAPT) cessation patterns <= 2 years after PCI and the subsequent risk of clinical adverse events. METHODS AND RESULTS: PARIS (Patterns of Non-Adherence to Dual Anti-Platelet Regimen in Stented Patients) was a prospective multicenter observational registry of PCI-treated patients (n.5018). Anemia was defined as baseline Hb (hemoglobin) <12 g/dL for men and <11 g/dL for women. DAPT cessation modes included physician-recommended discontinuation, temporary interruption (<= 14 days), and disruption due to bleeding or noncompliance. The primary end point was 2-year major adverse cardiovascular events (MACE), a composite of cardiac death, myocardial infarction, or target vessel revascularization. We identified 824 (18%) anemic and 4194 (82%) nonanemic patients. Anemic patients were older and had a higher rate of diabetes mellitus, hypertension, and prior PCI. DAPT interruption and disruption were significantly more common in anemic patients throughout 2 years after PCI, whereas physician-recommended discontinuation occurred more often in anemic patients during the first year after PCI and in nonanemic patients during the second year. The 2-year adjusted risks of MACE and Bleeding Academic Research Consortium 3 or 5 bleeding events were significantly higher in anemic patients. Compared with uninterrupted DAPT, disruption, but not interruption and physician-recommended discontinuation, was associated with a higher risk of myocardial infarction in nonanemic patients and a higher risk of both myocardial infarction and MACE in anemic patients. There was no significant interaction between anemia and risk of clinical outcomes associated with each DAPT cessation mode. CONCLUSIONS: Baseline anemia was associated with a significantly higher adjusted risk of MACE and major bleeding. Physicians more frequently recommend DAPT discontinuation to anemic patients during the first year, and to nonanemic patients during the second year after PCI. DAPT disruption was associated with a higher risk of MACE outcomes.
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页数:9
相关论文
共 18 条
[1]   Coronary Thrombosis and Major Bleeding After PCI With Drug-Eluting Stents Risk Scores From PARIS [J].
Baber, Usman ;
Mehran, Roxana ;
Giustino, Gennaro ;
Cohen, David J. ;
Henry, Timothy D. ;
Sartori, Samantha ;
Ariti, Cono ;
Litherland, Claire ;
Dangas, George ;
Gibson, C. Michael ;
Krucoff, Mitchell W. ;
Moliterno, David J. ;
Kirtane, Ajay J. ;
Stone, Gregg W. ;
Colombo, Antonio ;
Chieffo, Alaide ;
Kini, Annapoorna S. ;
Witzenbichler, Bernhard ;
Weisz, Giora ;
Steg, Philippe Gabriel ;
Pocock, Stuart .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2016, 67 (19) :2224-2234
[2]   Clinical end points in coronary stent trials - A case for standardized definitions [J].
Cutlip, Donald E. ;
Windecker, Stephan ;
Mehran, Roxana ;
Boam, Ashley ;
Cohen, David J. ;
van Es, Gerrit-Anne ;
Steg, P. Gabriel ;
Morel, Marie-angele ;
Mauri, Laura ;
Vranckx, Pascal ;
McFadden, Eugene ;
Lansky, Alexandra ;
Hamon, Martial ;
Krucoff, Mitchell W. ;
Serruys, Patrick W. .
CIRCULATION, 2007, 115 (17) :2344-2351
[3]   Flexible smoothing with B-splines and penalties [J].
Eilers, PHC ;
Marx, BD .
STATISTICAL SCIENCE, 1996, 11 (02) :89-102
[4]   Impact of Anemia on Platelet Reactivity and Ischemic and Bleeding Risk: From the Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents Study [J].
Giustino, Gennaro ;
Kirtane, Ajay J. ;
Baber, Usman ;
Genereux, Philippe ;
Witzenbichler, Bernhard ;
Neumann, Franz-Josef ;
Weisz, Giora ;
Maehara, Akiko ;
Rinaldi, Michael J. ;
Metzger, Christopher ;
Henry, Timothy D. ;
Cox, David A. ;
Duffy, Peter L. ;
Mazzaferri, Ernest L. ;
Brodie, Bruce R. ;
Stuckey, Thomas D. ;
Gurbel, Paul A. ;
Dangas, George D. ;
Francese, Dominic P. ;
Ozan, Ozgu ;
Mehran, Roxana ;
Stone, Gregg W. .
AMERICAN JOURNAL OF CARDIOLOGY, 2016, 117 (12) :1877-1883
[5]   Evaluation and management of anemia in the elderly [J].
Goodnough, Lawrence Tim ;
Schrier, Stanley L. .
AMERICAN JOURNAL OF HEMATOLOGY, 2014, 89 (01) :88-96
[6]   2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation [J].
Ibanez, Borja ;
James, Stefan ;
Agewall, Stefan ;
Antunes, Manuel J. ;
Bucciarelli-Ducci, Chiara ;
Bueno, Hector ;
Caforio, Alida L. P. ;
Crea, Filippo ;
Goudevenos, John A. ;
Halvorsen, Sigrun ;
Hindricks, Gerhard ;
Kastrati, Adnan ;
Lenzen, Mattie J. ;
Prescott, Eva ;
Roffi, Marco ;
Valgimigli, Marco ;
Varenhorst, Christoph ;
Vranckx, Pascal ;
Widimsky, Petr .
KARDIOLOGIA POLSKA, 2018, 76 (02) :229-313
[7]   Effect of Anemia on Frequency of Short- and Long-Term Clinical Events in Acute Coronary Syndromes (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial) [J].
Kunadian, Vijay ;
Mehran, Roxana ;
Lincoff, A. Michael ;
Feit, Frederick ;
Manoukian, Steven V. ;
Hamon, Martial ;
Cox, David A. ;
Dangas, George D. ;
Stone, Gregg W. .
AMERICAN JOURNAL OF CARDIOLOGY, 2014, 114 (12) :1823-1829
[8]   Meta-Analysis of the Prognostic Impact of Anemia in Patients Undergoing Percutaneous Coronary Intervention [J].
Kwok, Chun Shing ;
Tiong, Denise ;
Pradhan, Ashish ;
Andreou, Andreas Y. ;
Nolan, James ;
Bertrand, Olivier F. ;
Curzen, Nick ;
Urban, Philip ;
Myint, Phyo K. ;
Zaman, Azfar G. ;
Loke, Yoon K. ;
Mamas, Mamas A. .
AMERICAN JOURNAL OF CARDIOLOGY, 2016, 118 (04) :610-620
[9]   Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study [J].
Mehran, Roxana ;
Baber, Usman ;
Steg, Philippe Gabriel ;
Ariti, Cono ;
Weisz, Giora ;
Witzenbichler, Bernhard ;
Henry, Timothy D. ;
Kini, Annapoorna S. ;
Stuckey, Thomas ;
Cohen, David J. ;
Berger, Peter B. ;
Iakovou, Ioannis ;
Dangas, George ;
Waksman, Ron ;
Antoniucci, David ;
Sartori, Samantha ;
Krucoff, Mitchell W. ;
Hermiller, James B. ;
Shawl, Fayaz ;
Gibson, C. Michael ;
Chieffo, Alaide ;
Alu, Maria ;
Moliterno, David J. ;
Colombo, Antonio ;
Pocock, Stuart .
LANCET, 2013, 382 (9906) :1714-1722
[10]   A Risk Score to Predict Bleeding in Patients With Acute Coronary Syndromes [J].
Mehran, Roxana ;
Pocock, Stuart J. ;
Nikolsky, Eugenia ;
Clayton, Tim ;
Dangas, George D. ;
Kirtane, Ajay J. ;
Parise, Helen ;
Fahy, Martin ;
Manoukian, Steven V. ;
Feit, Frederick ;
Ohman, Magnus E. ;
Witzenbichler, Bernard ;
Guagliumi, Giulio ;
Lansky, Alexandra J. ;
Stone, Gregg W. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (23) :2556-2566