DAPT discontinuation after PCI safe in patients presenting with acute coronary syndrome
Physician-guided cessation of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) is safe in patients presenting with acute coronary syndrome (ACS), a recent study has shown.
The study included 5,018 PCI patients (mean age 63.4 years; 25.4 percent female), of whom 41 percent (n=2,056) presented with ACS. Three modes of DAPT cessation were assessed: discontinuation, interruption and disruption.
Analysis by ACS presentation showed that 2-year DAPT discontinuation rates were comparable between patients with vs without ACS (37.2 percent vs 38.8 percent; p=0.25). In comparison, DAPT in those who presented with ACS was less likely to be interrupted (8.5 percent vs 10.7 percent; p<0.001) but more likely to be disrupted (16.4 percent vs 11.9 percent; p<0.001).
DAPT disruption in ACS-presenting participants was driven mostly by noncompliance (11.6 percent vs 7.6 percent; p<0.001) than by discontinuation due to bleeding complications (5.6 percent vs 4.6 percent; p=0.10).
In terms of outcomes, patients who presented with ACS at baseline were at a significantly higher risk of major adverse cardiovascular events (MACE; 8.12 percent vs 5.43 percent; p=0.0002). This was driven primarily by stent thrombosis (p=0.0006) and spontaneous myocardial infarction (MI; p=0.0002).
When the definition of MACE was narrowed to include only cardiac death, stent thrombosis and MI, researchers found that the corresponding risk was elevated in ACS-presenting patients with DAPT interruption (hazard ratio, 2.72; 95 percent CI, 1.35–5.48). Notably, no such effects were observed for those with DAPT disruption or discontinuation.