Author + information
- Lauren C. Joyce, BSa,
- Usman Baber, MD, MSa,
- Bimmer E. Claessen, MD, PhDa,
- Samantha Sartori, PhDa,
- Jaya Chandrasekhar, MBBSa,
- David J. Cohen, MD, MScb,
- Timothy D. Henry, MDc,
- Cono Ariti, MScd,
- George Dangas, MD, PhDa,
- Michela Faggioni, MDa,
- Shunsuke Aoi, MDa,
- C. Michael Gibson, MDe,
- Melissa Aquino, MSa,
- Mitchell W. Krucoff, MDf,
- Birgit Vogel, MDa,
- David J. Moliterno, MDg,
- Sabato Sorrentino, MDa,
- Antonio Colombo, MDh,
- Alaide Chieffo, MDi,
- Annapoorna Kini, MDa,
- Paul Guedeney, MDa,
- Bernhard Witzenbichler, MDj,
- Giora Weisz, MDk,
- Philippe Gabriel Steg, MDl,
- Stuart Pocock, PhDd and
- Roxana Mehran, MDa,∗ ()
- aInterventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- bSt. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
- cMinneapolis Heart Institute Foundation, Minneapolis, Minnesota
- dLondon School of Hygiene and Tropical Medicine, London, United Kingdom
- eDivision of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- fDuke University School of Medicine, Durham, North Carolina
- gUniversity of Kentucky, Lexington, Kentucky
- hVilla Maria Cecilia GVM Hospital, Ravenna, Italy
- iCardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy
- jHelios Amper-Klinikum, Dachau, Germany
- kShaare Zedek Medical Center, Jerusalem, Israel
- lUniversité Paris-Diderot, Sorbonne Paris-Cité, Paris, France
- ↵∗Address for Correspondence: Roxana Mehran, MD, FACC, FAHA, FESC Mount Sinai School of Medicine One Gustave L. Levy Place Box1030 New York, NY 10029-6574
Objectives To examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention (PCI) in relation to age.
Background Examination of outcomes by age after PCI is relevant given the aging population.
Methods Two-year clinical outcomes, incidence and effect of DAPT cessation on outcomes were compared by ages ≤55, 56-74, and ≥75 years from the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) registry. DAPT cessation included physician- recommended discontinuation, interruption for surgery, and disruption (from non-compliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a secondary restrictive definition of MACE (MACE2) excluding target lesion revascularization, and bleeding.
Results A total of 1,192 (24%) patients were ≤55 years, 2,869 (57%) were 56-74 years, and 957 (19%) were ≥75 years. Patients ≥75 years had higher DAPT cessation rates and increased risk of MACE2, death, cardiac death, and bleeding compared to younger patients. Discontinuation and interruption were not associated with increased cardiovascular risk across age groups, whereas disruption was associated with increased risk for MACE and MACE2 in younger patients, but not in patients ≥75 years (p-for-trend <0.05).
Conclusion Non-adherence and outcomes vary by age with patients ≥75 years having the highest DAPT cessation rates. We observed no association between outcomes and DAPT cessation in patients ≥75 years, whereas discontinuation was associated with lower MACE rates and disruption with increased MACE rates in patients <75 years.
Dr. Cohen has received research grant support from Daiichi-Sankyo, Abbott Vascular, Boston Scientific, and Medtronic; and is a consultant for Medtronic.
Dr. Henry has received research grant support from Eli Lilly & Company/Daiichi-Sankyo.
Dr. Dangas has received consulting fees from Bayer, Daiichi-Sankyo, AstraZeneca, and Sanofi; and has received speaking honoraria from Bayer and Daiichi-Sankyo.
Dr. Gibson has received research support and consulting fees from Bayer, Janssen Pharmaceuticals, Johnson & Johnson, and Portola Pharmaceuticals.
Dr. Moliterno has received consulting fees from Janssen Pharmaceuticals and research grant support from AstraZeneca.
Dr. Colombo has received consulting fees and honoraria from Carbostent and Implantable Devices (CID); and other fees from Direct Flow Medical.
Dr. Steg has received research grant support from Amarin, Bayer, Merck, Sanofi, and Servier; and has receivedspeaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer, Janssen Pharmaceuticals, Boehringer-Ingelheim, Bristol-Myers-Squibb, Idorsia, Eli Lilly and Company, Merck, Novartis, Novo-Nordisk, Pfizer, Regeneron, Sanofi and Servier.
Dr. Mehran has received research funding from AstraZeneca, Bayer, Beth Israel Deaconess, Bristol-Myers-Squibb, is a consultant to Abbott Laboratories, Abiomed, Boston Scientific, Cardiovascular Systems, Medscape, Siemens Medical Solutions, The Medicines Company, PLx Opco, Regeneron, Roivant Sciences, Spectranetics/Phillips/Volcano Corporation; is part of the executive committees of Janssen Pharmaceuticals and Osprey Medical; is part of the advisory board of Bristol-Myers-Squibb; is a DSMB member of Watermark Research Partners; and has received equity from Claret Medical and Elixir Medical.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The PARIS study was supported by research grants from Bristol-Myers Squibb and Sanofi.
- Received December 21, 2018.
- Revision received February 23, 2019.
- Accepted February 25, 2019.
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