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：11

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

共 31 条

[31] Development and Validation of a Prediction Rule for Benefit and Harm of Dual Antiplatelet Therapy Beyond 1 Year After Percutaneous Coronary Intervention
Yeh, Robert W.
Secemsky, Eric A.
Kereiakes, Dean J.
Normand, Sharon-Lise T.
Gershlick, Anthony H.
Cohen, David J.
Spertus, John A.
Steg, Philippe Gabriel
Cutlip, Donald E.
Rinaldi, Michael J.
Camenzind, Edoardo
Wijns, William
Apruzzese, Patricia K.
Song, Yang
Massaro, Joseph M.
Mauri, Laura
[J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2016, 315 (16): : 1735 - 1749

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