Patterns and Impact of Dual Antiplatelet Cessation on Cardiovascular Risk After Percutaneous Coronary Intervention in
Mikkel Schoos1, David Power1, Usman Baber1
1The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Dual-antiplatelet therapy (DAPT) cessation patterns vary between acute coronary syndrome (ACS) and non-ACS patients post-percutaneous coronary intervention (PCI). Disruption of DAPT is linked to major adverse cardiovascular events (MACE) in both groups.
Area of Science:
- Cardiology
- Clinical Medicine
- Pharmacology
Background:
- Dual-antiplatelet therapy (DAPT) is crucial after percutaneous coronary intervention (PCI) to prevent stent thrombosis and ischemic events.
- Understanding patterns and clinical impact of DAPT cessation is vital for optimizing patient outcomes.
- Acute coronary syndromes (ACS) represent a critical subgroup with potentially different DAPT cessation needs and risks.
Purpose of the Study:
- To investigate the patterns of DAPT cessation (discontinuation, interruption, disruption) after PCI.
- To compare these cessation patterns between patients with and without ACS.
- To evaluate the clinical impact, specifically major adverse cardiovascular events (MACE), associated with different DAPT cessation modes.
Main Methods:
- Analysis of data from the PARIS registry, a multicenter study of 5,018 patients undergoing PCI.
- Categorization of DAPT cessation into physician-recommended discontinuation, interruption, and disruption.
- Comparison of cessation rates and MACE incidence between ACS and non-ACS patient groups using statistical analysis, including hazard ratios.
Main Results:
- Overall 2-year DAPT discontinuation rates were similar between non-ACS and ACS patients (38.8% vs 37.2%).
- ACS patients showed lower interruption rates (8.5% vs 10.7%) but higher disruption rates (16.4% vs 11.9%) compared to non-ACS patients.
- DAPT disruption predicted MACE in both ACS (HR 2.89) and non-ACS (HR 2.08) patients. DAPT interruption predicted MACE in ACS patients (HR 2.72) but not non-ACS patients.
Conclusions:
- Modes of DAPT cessation differ significantly based on ACS presentation.
- Physician-guided discontinuation was the most common and appears safe.
- DAPT disruption is associated with increased MACE risk in both ACS and non-ACS patients, while interruption poses a risk primarily in ACS patients.
Abstract:
The aim of this study was to examine the patterns and clinical impact of differing modes of dual-antiplatelet therapy (DAPT) cessation after percutaneous coronary intervention (PCI) in patients presenting with and without acute coronary syndromes (ACS). The PARIS (patterns of nonadherence to antiplatelet regimens in stented patients) registry was a multicenter study of 5,018 patients who underwent PCI. DAPT cessation was categorized as physician-recommended discontinuation, interruption, or disruption. Overall rates of 2-year DAPT discontinuation did not differ between non-ACS and ACS patients (38.8% vs 37.2%, p = 0.252). ACS patients were less likely to interrupt DAPT (8.5% vs 10.7% p<0.001), but were more likely to disrupt DAPT (16.4% vs 11.9%, p<0001). Adverse events after DAPT cessation were highest after disruption, intermediate with discontinuation, and lowest with interruption across both groups. Disruption of DAPT predicted MACE in both ACS patients (hazard ratio [HR] 2.89 [1.88 to 4.45; p<0.001]) and non-ACS patients (HR 2.08 [1.29 to 3.35; p = 0.002]). Interruption of DAPT predicated MACE in ACS patients (HR 2.72 [1.35 to 5.48]) but not in non-ACS patients (HR 0.44 [0.14 to 1.40]; pinteraction≤0.01). In conclusion, the incidence of DAPT cessation mode differs by presentation with or without ACS. Physician guided DAPT discontinuation was the most common mode of DAPT cessation and appears to be safe across both groups. There were higher rates of adverse events associated with the interruption of DAPT in ACS patients.
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