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Geographical Variations in Patterns of DAPT Cessation and Two-Year PCI Outcomes: Insights from the PARIS Registry.
Vogel, Birgit; Chandrasekhar, Jaya; Baber, Usman; Mastoris, Ioannis; Sartori, Samantha; Aquino, Melissa; Krucoff, Mitchell W; Moliterno, David J; Henry, Timothy D; Weisz, Giora; Gibson, C Michael; Iakovou, Ioannis; Kini, Annapoorna S; Farhan, Serdar; Sorrentino, Sabato; Faggioni, Michela; Colombo, Antonio; Steg, Philippe Gabriel; Witzenbichler, Bernhard; Chieffo, Alaide; Cohen, David J; Stuckey, Thomas; Ariti, Cono; Dangas, George D; Pocock, Stuart; Mehran, Roxana.
Afiliación
  • Vogel B; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Chandrasekhar J; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Baber U; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Mastoris I; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Sartori S; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Aquino M; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Krucoff MW; Duke University School of Medicine, Durham, North Carolina, United States.
  • Moliterno DJ; University of Kentucky, Lexington, Kentucky, United States.
  • Henry TD; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, United States.
  • Weisz G; Montefiore Medical Center, New York, New York, United States.
  • Gibson CM; Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States.
  • Iakovou I; Onassis Cardiac Surgery Centre, Athens, Greece.
  • Kini AS; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Farhan S; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Sorrentino S; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Faggioni M; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Colombo A; San Raffaele Scientific Institute, Milan, Italy.
  • Steg PG; Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
  • Witzenbichler B; Helios Amper-Klinikum, Dachau, Germany.
  • Chieffo A; San Raffaele Scientific Institute, Milan, Italy.
  • Cohen DJ; St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri, United States.
  • Stuckey T; Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina, United States.
  • Ariti C; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Dangas GD; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
  • Pocock S; London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Mehran R; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Thromb Haemost ; 119(10): 1704-1711, 2019 10.
Article en En | MEDLINE | ID: mdl-31365942
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.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 / 6_ODS3_enfermedades_notrasmisibles Problema de salud: 1_doencas_nao_transmissiveis / 2_muertes_prematuras_enfermedades_notrasmisibles / 6_cardiovascular_diseases Asunto principal: Inhibidores de Agregación Plaquetaria / Enfermedades Cardiovasculares / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Thromb Haemost Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 1_ASSA2030 / 2_ODS3 / 6_ODS3_enfermedades_notrasmisibles Problema de salud: 1_doencas_nao_transmissiveis / 2_muertes_prematuras_enfermedades_notrasmisibles / 6_cardiovascular_diseases Asunto principal: Inhibidores de Agregación Plaquetaria / Enfermedades Cardiovasculares / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte / Europa Idioma: En Revista: Thromb Haemost Año: 2019 Tipo del documento: Article País de afiliación: Estados Unidos
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