Sorrentino S, et al. - The risk for adverse events following drug-eluting stent implantation and its relationship with the mode of dual antiplatelet therapy (DAPT) cessation in patients at atherothrombotic risk (HATR) were described. Outcomes suggest that the degree of atherothrombotic risk determines the pattern and mode of DAPT cessation with less discontinuation among patients considered HATR. Researchers identified no influence of atherothrombotic risk (ATR) status on the link between DAPT cessation and cardiac risk.

Methods

• Patients treated with drug-eluting stents among those enrolled in the PARIS registry were included to define subjects with prior myocardial infarction (MI), prior stroke or peripheral vascular disease at HATR, while patients without any of these conditions were classified as atherothrombotic risk (LATR).
• Researchers defined DAPT cessation-modes as follows: physician-recommended discontinuation, temporary interruption, and disruption due to bleeding or poor compliance.

Results

• Patients with HATR (n=1,340; 31.8%) were older with a higher prevalence of cardiovascular risk factors vs patients with LATR (n=2867; 68.2%).
• Over 2 years, researchers observed lower rates of physician-recommended discontinuation (32.5% vs 39.4%; p=0.002) and trend for disruption (11.5% vs 13.7%, p=0.051) among HATR patients, however, there was no significant difference in the rate of DAPT interruption.
• They noted higher 2-year rates of cardiac death, MI or stent thrombosis among patients with HATR compared with those at LATR (8.7% vs 4.0%; adjusted hazard ratio [aHR]: 1.80; 95% confidence interval [CI]: 1.36-2.39; p < 0.0001).
• Disruption of DAPT was correlated with higher risk for cardiac death, MI or stent thrombosis in both HATR (aHR: 1.86; 95% CI: 1.05 – 3.46) and LATR (aHR: 2.84; 95% CI: 1.68 – 4.80) patients (p_interaction=0.40).