Incidence, Patterns, and Associations Between Dual-Antiplatelet Therapy Cessation and Risk for Adverse Events Among Patients With and Without Diabetes Mellitus Receiving Drug-Eluting Stents: Results From the PARIS Registry.
The aim of this study was to examine the frequency and clinical impact of different cessation patterns of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents among patients with and those without diabetes mellitus (DM).



Early DAPT suspension after percutaneous coronary intervention increases the risk for major adverse cardiac events. However, temporal variability in risk and relation to DAPT cessation patterns among patients with DM remain unclear.



Using data from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) registry, 1,430 patients with DM (34%) and 2,777 without DM (66%) treated with drug-eluting stents were identified. DAPT cessation modes were classified as temporary interruption (<14 days), disruption because of bleeding or poor compliance, and physician-recommended discontinuation.



During 2-year follow-up, DM was associated with an increased risk for thrombotic events but a similar risk for bleeding. The cumulative incidence of DAPT cessation was significantly lower in patients with versus those without DM (50.1% vs. 55.4%; p < 0.01), driven largely by less frequent physician-guided discontinuation beyond 1 year. In contrast, 2-year rates of interruption and disruption were similar between groups. When DAPT was interrupted or discontinued under physician guidance, the risk for major adverse cardiac events was unchanged compared with patients with DM on uninterrupted DAPT. Conversely, when DAPT was disrupted, the risk for major adverse cardiac events increased compared with uninterrupted DAPT, regardless of diabetic status, with no evidence of statistical interaction.



DAPT cessation patterns vary according to diabetic status, with less frequent physician-guided discontinuation among patients with DM. The presence of DM does not emerge as a modifier of cardiovascular risk after DAPT cessation.
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York; Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
Michela
M
Faggioni
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Usman
U
Baber
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Samantha
S
Sartori
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Gennaro
G
Giustino
St. Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
David J
DJ
Cohen
Minneapolis Heart Institute Foundation, University of Minnesota, Minneapolis, Minnesota.
Timothy D
TD
Henry
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Serdar
S
Farhan
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Cono
C
Ariti
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
George
G
Dangas
Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Michael
M
Gibson
Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
Daniele
D
Giacoppo
Duke University School of Medicine, Durham, North Carolina.
Mitchell W
MW
Krucoff
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Melissa
M
Aquino
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Jaya
J
Chandrasekhar
University of Kentucky, Lexington, Kentucky.
David J
DJ
Moliterno
Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy.
Antonio
A
Colombo
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Birgit
B
Vogel
Cardio-Thoracic Department, San Raffaele Scientific Institute, Milan, Italy.
Alaide
A
Chieffo
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York.
Annapoorna S
AS
Kini
Helios Amper-Klinikum, Dachau, Germany.
Bernhard
B
Witzenbichler
Shaare Zedek Medical Center, Jerusalem, Israel.
Giora
G
Weisz
Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France.
Philippe Gabriel
PG
Steg
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Stuart
S
Pocock
Mount Sinai Heart, Mount Sinai Medical Center, New York, New York. Electronic address: roxana.mehran@mountsinai.org.
Roxana
R
Mehran
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003328:Coronary Thrombosis / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D054855:Drug-Eluting Stents; D004867:Equipment Design; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
DAPT cessation; bleeding; compliance; diabetes mellitus; dual-antiplatelet therapy