TY - JOUR
T1 - Double antiplatelet therapy after drug-eluting stent implantation: Risk associated with discontinuation within the first year
AU - Ferreira-González, Ignacio
AU - Marsal, Josep R.
AU - Ribera, Aida
AU - Permanyer-Miralda, Gaietà
AU - García-Del Blanco, Bruno
AU - Martí, Gerard
AU - Cascant, Purificación
AU - Masotti-Centol, Mónica
AU - Carrillo, Xavier
AU - Mauri, Josepa
AU - Batalla, Nuria
AU - Larrousse, Eduard
AU - Martín, Eva
AU - Serra, Antonio
AU - Rumoroso, José Ramón
AU - Ruiz-Salmerón, Rafael
AU - De La Torre, Jose M.
AU - Cequier, Angel
AU - Gómez-Hospital, Jose A.
AU - Alfonso, Fernando
AU - Martín-Yuste, Victoria
AU - Sabatè, Manel
AU - García-Dorado, David
PY - 2012/10/9
Y1 - 2012/10/9
N2 - Objectives: The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation. Background: Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation. Methods: A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events. Results: One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n = 111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n = 80; 5.5%; 95% CI: 4.4 to 6.8; p = 0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]). Conclusions: ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk. © 2012 American College of Cardiology Foundation.
AB - Objectives: The goal of this study was to assess the risk associated with double antiplatelet therapy (DAT) discontinuation, and specifically, temporary discontinuation, during the first year after drug-eluting stent (DES) implantation. Background: Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation. Methods: A total of 1,622 consecutive patients undergoing DES implantation at 29 hospitals were followed up at 3, 6, 9, and 12 months to record the 1-year antiplatelet therapy discontinuation (ATD) rate, the number of days without DAT, and the rate of 1-year major cardiac events. Cox regression was used to analyze the association between ATD considered as a time-dependent covariate and 1-year cardiac events. Results: One hundred seventy-two (10.6%) patients interrupted at least 1 antiplatelet drug during the first year after DES implantation, although only 1 during the first month. Most (n = 111, 64.5%) interrupted DAT temporarily (median: 7 days; range: 5 to 8.5): 79 clopidogrel (31 temporarily), 38 aspirin (27 temporarily), and 55 both drugs (53 temporarily). Discontinuation was followed by acute coronary syndrome in 7 (4.1%; 95% confidence interval [CI]: 1.7 to 8.2), a similar rate of major cardiac events to that in patients without ATD (n = 80; 5.5%; 95% CI: 4.4 to 6.8; p = 0.23). ATD was not independently associated with 1-year major cardiac events (hazard ratio: 1.32 [95% CI: 0.56 to 3.12]). Conclusions: ATD within the first year and beyond the first month after DES is not exceptional, is usually temporary, and does not appear to have a large impact on risk. © 2012 American College of Cardiology Foundation.
KW - adherence
KW - antiplatelet therapy
KW - compliance
KW - drug-eluting stents
KW - interruption
U2 - 10.1016/j.jacc.2012.04.057
DO - 10.1016/j.jacc.2012.04.057
M3 - Article
SN - 0735-1097
VL - 60
SP - 1333
EP - 1339
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 15
ER -