Author + information
- Received October 12, 2016
- Revision received December 5, 2016
- Accepted December 6, 2016
- Published online April 3, 2017.
- Michela Faggioni, MDa,b,
- Usman Baber, MD, MSa,
- Samantha Sartori, PhDa,
- Gennaro Giustino, MDa,
- David J. Cohen, MD, MScc,
- Timothy D. Henry, MDd,
- Serdar Farhan, MDa,
- Cono Ariti, MSce,
- George Dangas, MD, PhDa,
- Michael Gibson, MDf,
- Daniele Giacoppo, MDg,
- Mitchell W. Krucoff, MDh,
- Melissa Aquino, MSa,
- Jaya Chandrasekhar, MBBSa,
- David J. Moliterno, MDi,
- Antonio Colombo, MDj,
- Birgit Vogel, MDa,
- Alaide Chieffo, MDj,
- Annapoorna S. Kini, MDa,
- Bernhard Witzenbichler, MDk,
- Giora Weisz, MDl,
- Philippe Gabriel Steg, MDm,
- Stuart Pocock, PhDe and
- Roxana Mehran, MDa,∗ ()
- aMount Sinai Heart, Mount Sinai Medical Center, New York, New York
- bCardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy
- cSt. Luke’s Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri
- dMinneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, Minnesota
- eLondon School of Hygiene and Tropical Medicine, London, United Kingdom
- fDivision of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- gDeutsches Herzzentrum München, Technische Universität München, Munich, Germany
- hDuke University School of Medicine, Durham, North Carolina
- iUniversity of Kentucky, Lexington, Kentucky
- jCardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy
- kHelios Amper-Klinikum, Dachau, Germany
- lShaare Zedek Medical Center, Jerusalem, Israel
- mUniversité Paris-Diderot, Sorbonne Paris-Cité, Paris, France
- ↵∗Address for correspondence:
Dr. Roxana Mehran, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1030, New York, New York 10029.
Objectives The aim of this study was to examine the frequency and clinical impact of different cessation patterns of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents among patients with and those without diabetes mellitus (DM).
Background Early DAPT suspension after percutaneous coronary intervention increases the risk for major adverse cardiac events. However, temporal variability in risk and relation to DAPT cessation patterns among patients with DM remain unclear.
Methods Using data from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) registry, 1,430 patients with DM (34%) and 2,777 without DM (66%) treated with drug-eluting stents were identified. DAPT cessation modes were classified as temporary interruption (<14 days), disruption because of bleeding or poor compliance, and physician-recommended discontinuation.
Results During 2-year follow-up, DM was associated with an increased risk for thrombotic events but a similar risk for bleeding. The cumulative incidence of DAPT cessation was significantly lower in patients with versus those without DM (50.1% vs. 55.4%; p < 0.01), driven largely by less frequent physician-guided discontinuation beyond 1 year. In contrast, 2-year rates of interruption and disruption were similar between groups. When DAPT was interrupted or discontinued under physician guidance, the risk for major adverse cardiac events was unchanged compared with patients with DM on uninterrupted DAPT. Conversely, when DAPT was disrupted, the risk for major adverse cardiac events increased compared with uninterrupted DAPT, regardless of diabetic status, with no evidence of statistical interaction.
Conclusions DAPT cessation patterns vary according to diabetic status, with less frequent physician-guided discontinuation among patients with DM. The presence of DM does not emerge as a modifier of cardiovascular risk after DAPT cessation.
Dr. Cohen has received research grant support from Abbott Vascular, AstraZeneca, Boston Scientific, Daiichi-Sankyo, Eli Lilly & Company, and Medtronic; is a consultant for Cardinal Health, Medtronic, AstraZeneca, Eli Lilly; and has received speaking honoraria from AstraZeneca. Dr. Henry has received research grant support from Eli Lilly & Company and Daiichi-Sankyo. Dr. Dangas has received consulting fees and honoraria from Johnson & Johnson, Sanofi, Covidien, The Medicines Company, Merck, CSL Behring, AstraZeneca, Medtronic, Abbott Vascular, Bayer, Boston Scientific, Osprey Medical, and GE Healthcare; and research grant support from Sanofi, Bristol-Myers Squibb, and Eli Lilly & Company/Daiichi-Sankyo. Dr. Gibson has received research grant support from Angel Medical Corporation, Atrium Medical Systems, Bayer Corporation, Ikaria, Janssen/Johnson & Johnson Corporation, Lantheus Medical Imaging, Merck & Company, Portola Pharmaceuticals, Roche Diagnostics, Sanofi, Stealth Peptides, St. Jude Medical, Volcano Corporation, and Walk Vascular; consulting fees from AstraZeneca, Baxter Healthcare, Bayer Corporation, CRF, Consensus Medical Communications, CSL Behring, Cytori Therapeutics, Eli Lilly & Company/Daiichi-Sankyo, Exeter Group, Genentech, GlaxoSmithKline, Janssen/Johnson & Johnson Corporation, Ortho McNeil, St. Jude Medical, and The Medicines Company; and royalty fees from UpToDate in Cardiovascular Medicine. Dr. Krucoff has received consulting fees from Abbott Vascular, Abbott Laboratories, OrbusNeich, Angelmed, Volcano Corp., Biosensors, Svelte, Medtronic, and Terumo; and research grant support from Abbott Vascular, Terumo, Angelmed, Ikaria, OrbusNeich, Cardiovascular Systems, Inc. (CSI), Eli Lilly & Company, and Medtronic. Dr. Colombo has received consulting fees and honoraria from Carbostent and Implantable Devices (CID) and other financial benefit from Direct Flow Medical. Dr. Kini serves on the Speakers Bureau of the American College of Cardiology; and has received consulting fees from WebMD. Dr. Witzenbichler is a consultant for Volcano Corporation. Dr. Steg has served as an adviser or a consultant for Amarin Corporation, AstraZeneca Pharmaceuticals, Bayer HealthCare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Bristol-Myers Squibb, Daiichi-Sankyo, GlaxoSmithKline, Eli Lilly & Company, Medtronic, Otsuka Pharmaceutical, Pfizer, Roche, Sanofi, Servier, Takeda Pharmaceuticals North America, The Medicines Company, and Vivus; and has received clinical research grants from Sanofi and Servier. Dr. Mehran has received institutional grant support from The Medicines Company, Bristol-Myers Squibb/Sanofi, Eli Lilly and Company/Daiichi-Sankyo, OrbusNeich, Bayer, and CSL Behring; is a consultant to Janssen Pharmaceuticals, Osprey Medical, Watermark Research Partners, and Medscape; and is part of the advisory board of Abbott Laboratories. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 12, 2016.
- Revision received December 5, 2016.
- Accepted December 6, 2016.
- 2017 American College of Cardiology Foundation