While older age may be associated with higher incidence of dual-antiplatelet therapy (DAPT) cessation due to discontinuation or interruption, disruption displays a bimodal pattern that may occur more frequently in both younger and older patients, according to research published March 4 in JACC: Cardiovascular Interventions which will be presented during ACC.19 in New Orleans, LA.

Lauren C. Joyce, BS, et al., used data from the PARIS registry to examine two-year clinical outcomes, incidence and effect of DAPT cessation after PCI compared by age. DAPT cessation included physician- recommended discontinuation, interruption for surgery and disruption. Clinical endpoints included major adverse cardiac events (MACE) – defined as the composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction (MI), or clinically indicated target lesion revascularization – and a secondary restrictive definition of MACE (MACE2) – defined as cardiac death, definite or probable stent thrombosis, and spontaneous MI.

Results showed that of 5,018 patients, 1,192 patients were 55 years or younger, 2,869 were 56-74 years, and 957 were 75 years or older. Patients 75 years or older were found to have higher DAPT cessation rates and increased risk of MACE2, death, cardiac death and bleeding compared to younger patients. However, discontinuation and interruption were not associated with increased cardiovascular risk across age groups, and disruption was associated with increased risk for MACE and MACE2 in younger patients but not in patients 75 years or older.

The authors note that high incidences of adverse events found among the oldest age group were expected since older patient populations are typically burdened with more comorbidity. On the other hand, since age wasn't a modifier of risk of adverse cardiovascular events after discontinuation or interruption, results should support the use of physician-recommended discontinuation and interruption as safe clinical practices.

"Future prospective studies should be conducted to investigate the safety and efficacy of shortened DAPT in older patients," the authors conclude. "In younger patients, strategies should be developed to optimize medication adherence and mitigate risk for adverse cardiovascular events after disruption."

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention

Keywords: ACC19, ACC Annual Scientific Session, Prospective Studies, Incidence, Medication Adherence, Cardiovascular Diseases, Risk Factors, Myocardial Infarction, Hemorrhage, Registries, Comorbidity, Thrombosis, Percutaneous Coronary Intervention, Stents

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