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

被引：12

作者：

Chandrasekhar, Jaya ^{[1
]}

Baber, Usman ^{[1
]}

Sartori, Samantha ^{[1
]}

Aquino, Melissa ^{[1
]}

Tomey, Matthew ^{[1
]}

Kruckoff, Mitchell ^{[2
]}

Moliterno, David ^{[3
]}

Henry, Timothy D. ^{[4
]}

Weisz, Giora ^{[5
]}

Gibson, C. Michael ^{[6
]}

Iakovou, Ioannis ^{[7
]}

Kini, Annapoorna ^{[1
]}

Faggioni, Michela ^{[1
]}

Vogel, Birgit ^{[1
]}

Farhan, Serdar ^{[1
]}

Colombo, Antonio ^{[8
]}

Steg, P. Gabriel ^{[9
]}

Witzenbichler, Bernhard ^{[10
]}

Chieffo, Alaide ^{[8
]}

Cohen, David ^{[11
]}

Stuckey, Thomas ^{[12
]}

Ariti, Cono ^{[13
]}

Pocock, Stuart ^{[13
]}

Dangas, George ^{[1
]}

Mehran, Roxana ^{[1
]}

机构：

[1] Icahn Sch Med Mt Sinai, New York, NY 10029 USA

[2] Duke Univ, Sch Med, Durham, NC USA

[3] Univ Kentucky, Lexington, KY USA

[4] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[5] Shaare Zedek Med Ctr, Jerusalem, Israel

[6] Harvard Med Sch, Cambridge, MA USA

[7] Onassis Cardiac Surg Ctr, Athens, Greece

[8] Osped San Raffaele, Milan, Italy

[9] Hop Bichat Claude Bernard, Paris, France

[10] Helios Amper Klinikum, Dachau, Germany

[11] Univ Missouri, St Lukes Mid Amer Heart Inst, Kansas City, MO 64110 USA

[12] LeBauer Cardiovasc Res Fdn, Moses Cone Heart & Vasc Ctr, Greensboro, NC USA

[13] London Sch Hyg & Trop Med, London, England

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2017年 / 243卷

关键词：

Left main or proximal LAD; Percutaneous coronary intervention; Dual antiplatelet therapy cessation; Drug eluting stents; Major adverse cardiac events; PERCUTANEOUS CORONARY INTERVENTION; EVEROLIMUS-ELUTING STENTS; BYPASS-SURGERY; THROMBOSIS; RISK; IMPLANTATION; DISEASE; TAXUS; BIFURCATIONS; PROPENSITY;

D O I：

10.1016/j.ijcard.2017.05.049

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2017 Elsevier B.V. All rights reserved.

引用

页码：132 / 139

页数：8

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