Double Antiplatelet Therapy After Drug-Eluting Stent Implantation Risk Associated With Discontinuation Within the First Year

作者：Ferreira Gonzalez Ignacio^*; Marsal Josep R; Ribera Aida; Permanyer Miralda Gaieta; Garcia Del Blanco Bruno; Marti Gerard; Cascant Purificacion; Masotti Centol Monica; Carrillo Xavier; Mauri Josepa; Batalla Nuria; Larrousse Eduard; Martin Eva; Serra Antonio; Ramon Rumoroso Jose; Ruiz Salmeron Rafael; de la Torre Jose M; Cequier Angel; Gomez Hospital Jose A; Alfonso Fernando; Martin Yuste Victoria; Sabate Manel; Garcia Dorado David

来源：Journal of the American College of Cardiology, 2012, 60(15): 1333-1339.

DOI：10.1016/j.jacc.2012.04.057

• adherence
• antiplatelet therapy
• compliance
• drug-eluting stents
• interruption

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. %26lt;br%26gt;Background Doubts remain about the risk of temporary DAT discontinuation within 1 year after DES implantation. %26lt;br%26gt;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. %26lt;br%26gt;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]). %26lt;br%26gt;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.

• 出版日期2012-10-9