Michela Faggioni1, Usman Baber2, Samantha Sartori2, Gennaro Giustino2, David J Cohen3, Timothy D Henry4, Serdar Farhan2, Cono Ariti5, George Dangas2, Michael Gibson6, Daniele Giacoppo7, Mitchell W Krucoff8, Melissa Aquino2, Jaya Chandrasekhar2, David J Moliterno9, Antonio Colombo10, Birgit Vogel2, Alaide Chieffo10, Annapoorna S Kini2, Bernhard Witzenbichler11, Giora Weisz12, Philippe Gabriel Steg13, Stuart Pocock5, Roxana Mehran14. 1. Mount Sinai Heart, Mount Sinai Medical Center, New York, New York; Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy. 2. Mount Sinai Heart, Mount Sinai Medical Center, New York, New York. 3. St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri. 4. Minneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, Minnesota. 5. London School of Hygiene and Tropical Medicine, London, United Kingdom. 6. Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 7. Deutsches Herzzentrum München, Technische Universität München, Munich, Germany. 8. Duke University School of Medicine, Durham, North Carolina. 9. University of Kentucky, Lexington, Kentucky. 10. Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy. 11. Helios Amper-Klinikum, Dachau, Germany. 12. Shaare Zedek Medical Center, Jerusalem, Israel. 13. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. 14. Mount Sinai Heart, Mount Sinai Medical Center, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Abstract
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.
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.
Authors: Eline H Ploumen; Tineke H Pinxterhuis; Paolo Zocca; Ariel Roguin; Rutger L Anthonio; Carl E Schotborgh; Edouard Benit; Adel Aminian; Peter W Danse; Carine J M Doggen; Clemens von Birgelen; Marlies M Kok Journal: Cardiovasc Diabetol Date: 2021-10-30 Impact factor: 9.951