Lauren C Joyce1, Usman Baber1, Bimmer E Claessen1, Samantha Sartori1, Jaya Chandrasekhar1, David J Cohen2, Timothy D Henry3, Cono Ariti4, George Dangas1, Michela Faggioni1, Shunsuke Aoi1, C Michael Gibson5, Melissa Aquino1, Mitchell W Krucoff6, Birgit Vogel1, David J Moliterno7, Sabato Sorrentino1, Antonio Colombo8, Alaide Chieffo9, Annapoorna Kini1, Paul Guedeney1, Bernhard Witzenbichler10, Giora Weisz11, Philippe Gabriel Steg12, Stuart Pocock4, Roxana Mehran13. 1. Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 2. St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri. 3. Minneapolis Heart Institute Foundation, Minneapolis, Minnesota. 4. London School of Hygiene and Tropical Medicine, London, United Kingdom. 5. Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts. 6. Duke University School of Medicine, Durham, North Carolina. 7. University of Kentucky, Lexington, Kentucky. 8. Villa Maria Cecilia GVM Hospital, Ravenna, Italy. 9. Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy. 10. Helios Amper-Klinikum, Dachau, Germany. 11. Shaare Zedek Medical Center, Jerusalem, Israel. 12. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France. 13. Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Abstract
OBJECTIVES: The aim of this study was to examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention in relation to age. BACKGROUND: Examination of outcomes by age after percutaneous coronary intervention 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 to 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 noncompliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (a 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 patients (24%) were ≤55 years, 2,869 (57%) were 56 to 74 years, and 957 (19%) were ≥75 years of age. Patients ≥75 years of age had higher DAPT cessation rates and increased risk for MACE2, death, cardiac death, and bleeding compared with 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 of age (p for trend <0.05). CONCLUSIONS: Nonadherence 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.
OBJECTIVES: The aim of this study was to examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention in relation to age. BACKGROUND: Examination of outcomes by age after percutaneous coronary intervention 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 to 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 noncompliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (a 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 patients (24%) were ≤55 years, 2,869 (57%) were 56 to 74 years, and 957 (19%) were ≥75 years of age. Patients ≥75 years of age had higher DAPT cessation rates and increased risk for MACE2, death, cardiac death, and bleeding compared with 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 of age (p for trend <0.05). CONCLUSIONS: Nonadherence 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.
Authors: Luigi Fiocca; Roberta Rossini; Greta Carioli; Alessandra Carobbio; Isabelle Piazza; Elona Collaku; Simona Giubilato; Francesco Amico; Maria Molfese; Mauro De Benedictis; Paolo Calabria; Ugo Limbruno; Serafina Valente; Marco Ferlini; Tiziana Spezzano; Michele Senni; Antonello Gavazzi Journal: Int J Cardiol Heart Vasc Date: 2022-07-18