Background:Whether the underlying risk of bleeding influences the associations between patterns of dual antiplatelet therapy (DAPT) cessation and adverse events after percutaneous coronary intervention is unknown.Methods:Patients enrolled in the prospective, international, multicenter PARIS registry (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) were categorized according to their risk of bleeding using the PARIS bleeding risk score. We evaluated the incidence, patterns, and association between modes of DAPT cessation and outcomes across bleeding risk groups. Modes of DAPT cessations were defined as physician-guided DAPT discontinuation, brief interruption (<14 days) or disruption for bleeding, or noncompliance. The primary end point of interest was major adverse cardiac events, defined as the composite of cardiac death, myocardial infarction, or definite-probable stent thrombosis.Results:From a total of 5018 patients, 513 (10.2%) were classified as high, 2058 (41.0%) as intermediate, and 2447 (48.8%) as low risk for bleeding. High bleeding risk (HBR) patients were older and had greater prevalence of comorbidities. Compared with non-HBR, HBR patients had higher rates of both ischemic and bleeding events. The cumulative incidence of DAPT cessation was higher in HBR patients, mostly driven by physician-guided discontinuation and disruption. Of note, DAPT disruption occurred in 17.7%, 10.4%, and 7.8% at 1 year and 22.0%, 15.1%, and 12.0% at 2 years (P<0.0001) in high, intermediate, and low bleeding risk groups, respectively. Physician-guided DAPT discontinuation was not associated with increased risk of major adverse cardiac events in both HBR and non-HBR patients, while DAPT disruption was associated with an increased risk of major adverse cardiac events across all bleeding risk groups. There was no interaction between bleeding risk status and clinical outcomes for any cessation mode.Conclusions:Patients at HBR remain at higher risk of adverse events. Disruption of DAPT is associated with an increased risk of major adverse cardiac events irrespective of the underlying bleeding risk. Physician-guided discontinuation of DAPT appears to be safe, irrespective of HBR.

中文翻译：

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经皮冠状动脉介入治疗后出血风险，双重抗血小板治疗停止和不良事件

背景：潜在的出血风险是否会影响双抗血小板治疗（DAPT）停止模式与经皮冠状动脉介入治疗后不良事件之间的关联。方法：纳入前瞻性，国际，多中心PARIS登记系统的患者使用PARIS出血风险评分，根据患者的出血风险对抗血小板治疗方案进行了分类。我们评估了出血风险组中DAPT戒断模式和预后之间的发生率，模式和关联。停止DAPT的方式定义为医生指导的DAPT停药，短暂中断（<14天）或因出血而中断或不依从。主要的研究终点是主要的不良心脏事件，结果：总共5018例患者中，高（513）（10.2％）被分类为高，2058（41.0％）为中度，2447（48.8％）被归为高。 ），因为出血风险低。高出血风险（HBR）患者年龄较大，合并症患病率更高。与非HBR相比，HBR患者的缺血和出血事件发生率更高。在HBR患者中，DAPT停止治疗的累积发生率较高，这主要是由医生指导的停药和治疗中断引起的。值得注意的是，一年中DAPT中断发生率分别为17.7％，10.4％和7.8％，两年后分别为22.0％，15.1％和12.0％（和2447（48.8％）作为低出血风险。高出血风险（HBR）患者年龄较大，合并症患病率更高。与非HBR相比，HBR患者的缺血和出血事件发生率更高。在HBR患者中，DAPT停止治疗的累积发生率较高，这主要是由医生指导的停药和治疗中断引起的。值得注意的是，一年中DAPT中断发生率分别为17.7％，10.4％和7.8％，两年后分别为22.0％，15.1％和12.0％（和2447（48.8％）作为低出血风险。高出血风险（HBR）患者年龄较大，合并症患病率更高。与非HBR相比，HBR患者的缺血和出血事件发生率更高。在HBR患者中，DAPT停止治疗的累积发生率较高，这主要是由医生指导的停药和治疗中断引起的。值得注意的是，一年中DAPT中断发生率分别为17.7％，10.4％和7.8％，两年后分别为22.0％，15.1％和12.0％（P <0.0001）分别在高，中和低出血风险组中。在所有出血风险组中，医师指导的DAPT停用与HBR和非HBR患者的主要不良心脏事件的风险增加均无关，而DAPT中断与所有出血风险组的重大不良心脏事件的风险均增加相关。结论：HBR患者的不良事件发生风险更高。不管潜在的出血风险如何，DAPT中断都会增加发生严重心脏不良事件的风险。医师指导的DAPT停药似乎是安全的，而与HBR无关。