DAPT Cessation and Risk for Adverse Events in DES Patients

Study Questions:

What is the frequency and clinical impact of cessation of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) among patients with and those without diabetes mellitus (DM)?

Methods:

The authors used data from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) registry to assess the impact of DAPT cessation on patients undergoing DES-based PCI. There were 1,430 patients with DM (34%) and 2,777 without DM (66%). DAPT cessation modes were classified as temporary interruption (<14 days), disruption because of bleeding or poor compliance, and physician-recommended discontinuation.

Results:

The cumulative incidence of DAPT cessation was lower in patients with DM versus those without DM (50.1% vs. 55.4%; p < 0.01), and this was mostly secondary to less frequent physician-guided discontinuation beyond 1 year. There was no difference in 2-year rates of interruption and disruption between the two groups. When DAPT was interrupted or discontinued under physician guidance, the risk for major adverse cardiac events was unchanged. When DAPT was disrupted, the risk for major adverse cardiac events increased compared with uninterrupted DAPT. Presence of diabetes did not impact both of these associations.

Conclusions:

The authors concluded that the presence of diabetes does not modify the impact of DAPT cessation among patients treated with DES.

Perspective:

The impact of DAPT cessation on thrombotic complications varies based on the circumstances. In general, physician-guided cessation is not associated with any increase in cardiovascular risk. This study suggests that this relationship is extant in patients with diabetes, and interruption or termination of DAPT should always be done under the careful guidance of a cardiologist.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Diabetes Mellitus, Drug-Eluting Stents, Hemorrhage, Patient Compliance, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Risk Factors, Stents, Thrombosis


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