Thromb Haemost 2019; 19(10): 1704-1711
DOI: 10.1055/s-0039-1693463
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry

Birgit Vogel
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Jaya Chandrasekhar
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Usman Baber
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Ioannis Mastoris
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Samantha Sartori
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Melissa Aquino
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Mitchell W. Krucoff
2  Duke University School of Medicine, Durham, North Carolina, United States
,
David J. Moliterno
3  University of Kentucky, Lexington, Kentucky, United States
,
4  The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, United States
,
Giora Weisz
5  Montefiore Medical Center, New York, New York, United States
,
C. Michael Gibson
6  Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
,
Ioannis Iakovou
7  Onassis Cardiac Surgery Centre, Athens, Greece
,
Annapoorna S. Kini
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Serdar Farhan
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Sabato Sorrentino
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Michela Faggioni
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Antonio Colombo
8  San Raffaele Scientific Institute, Milan, Italy
,
Philippe Gabriel Steg
9  Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France
,
Bernhard Witzenbichler
10  Helios Amper-Klinikum, Dachau, Germany
,
Alaide Chieffo
8  San Raffaele Scientific Institute, Milan, Italy
,
David J. Cohen
11  St. Luke's Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri, United States
,
Thomas Stuckey
12  Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, United States
,
Cono Ariti
13  London School of Hygiene and Tropical Medicine, London, United Kingdom
,
George D. Dangas
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
,
Stuart Pocock
13  London School of Hygiene and Tropical Medicine, London, United Kingdom
,
Roxana Mehran
1  The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
› Author Affiliations
Funding The PARIS registry was supported by research grants from Bristol-Myers Squibb and Sanofi-Aventis.
Further Information

Publication History

30 May 2019

21 January 2019

Publication Date:
31 July 2019 (eFirst)

Abstract

Background Data on geographical variations in dual antiplatelet therapy (DAPT) cessation and the impact on outcomes after percutaneous coronary intervention (PCI) are limited. We sought to evaluate geographical patterns of DAPT cessation and associated outcomes in patients undergoing PCI in the United States versus Europe.

Methods Analyzing data from the PARIS registry, we studied 3,660 U.S. patients (72.9%) and 1,358 European patients (27.1%) that underwent PCI with stent implantation. DAPT cessation was classified as physician-recommended discontinuation, interruption (< 14 days), or disruption due to bleeding or noncompliance. The primary endpoint was 2-year major adverse cardiovascular events (MACE) defined as a composite of cardiac death, stent thrombosis, myocardial infarction, or target lesion revascularization.

Results Cardiovascular risk factors were more common in the United States, whereas procedural complexity was greater in Europe. The incidence of 2-year DAPT discontinuation was significantly lower in U.S. versus European patients (30.7% vs. 65.6%; p < 0.001); however, rates of interruption (13.7% vs. 1.5%, p < 0.001) and disruption (17.7% vs. 5.1%, p < 0.001) were higher. DAPT discontinuation was associated with lower adjusted risk, whereas DAPT disruption was associated with greater risk for 2-year MACE, without interaction by region. After adjustment for baseline characteristics and DAPT cessation, 2-year MACE risk was not statistically different between regions (10.3% for Europe vs. 11.9% for U.S., adjusted hazard ratio 0.81, 95% confidence interval 0.65–1.01, p = 0.065).

Conclusion DAPT cessation patterns, along with clinical and angiographic risk, vary substantially between PCI patients in the U.S. versus Europe. Despite such differences, cardiovascular risk associated with DAPT cessation remains uniform.