• Michela Faggioni, Usman Baber, Samantha Sartori, Gennaro Giustino, David J Cohen, Timothy D Henry, Serdar Farhan, Cono Ariti, George Dangas, Michael Gibson, Daniele Giacoppo, Mitchell W Krucoff, Melissa Aquino, Jaya Chandrasekhar, David J Moliterno, Antonio Colombo, Birgit Vogel, Alaide Chieffo, Annapoorna S Kini, Bernhard Witzenbichler, Giora Weisz, Philippe Gabriel Steg, Stuart Pocock, and Roxana Mehran.
• Mount Sinai Heart, Mount Sinai Medical Center, New York, New York; Cardiothoracic Department, Division of Cardiology, University Hospital of Pisa, Pisa, Italy.
• JACC Cardiovasc Interv. 2017 Apr 10; 10 (7): 645-654.

ObjectivesThe aim of this study was to examine the frequency and clinical impact of different cessation patterns of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents among patients with and those without diabetes mellitus (DM).BackgroundEarly DAPT suspension after percutaneous coronary intervention increases the risk for major adverse cardiac events. However, temporal variability in risk and relation to DAPT cessation patterns among patients with DM remain unclear.MethodsUsing data from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) registry, 1,430 patients with DM (34%) and 2,777 without DM (66%) treated with drug-eluting stents were identified. DAPT cessation modes were classified as temporary interruption (<14 days), disruption because of bleeding or poor compliance, and physician-recommended discontinuation.ResultsDuring 2-year follow-up, DM was associated with an increased risk for thrombotic events but a similar risk for bleeding. The cumulative incidence of DAPT cessation was significantly lower in patients with versus those without DM (50.1% vs. 55.4%; p < 0.01), driven largely by less frequent physician-guided discontinuation beyond 1 year. In contrast, 2-year rates of interruption and disruption were similar between groups. When DAPT was interrupted or discontinued under physician guidance, the risk for major adverse cardiac events was unchanged compared with patients with DM on uninterrupted DAPT. Conversely, when DAPT was disrupted, the risk for major adverse cardiac events increased compared with uninterrupted DAPT, regardless of diabetic status, with no evidence of statistical interaction.ConclusionsDAPT cessation patterns vary according to diabetic status, with less frequent physician-guided discontinuation among patients with DM. The presence of DM does not emerge as a modifier of cardiovascular risk after DAPT cessation.Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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