• Jaya Chandrasekhar, Usman Baber, Samantha Sartori, Melissa Aquino, Matthew Tomey, Mitchell Kruckoff, David Moliterno, Timothy D Henry, Giora Weisz, C Michael Gibson, Ioannis Iakovou, Annapoorna Kini, Michela Faggioni, Birgit Vogel, Serdar Farhan, Antonio Colombo, P Gabriel Steg, Bernhard Witzenbichler, Alaide Chieffo, David Cohen, Thomas Stuckey, Cono Ariti, Stuart Pocock, George Dangas, and Roxana Mehran.
• Icahn School of Medicine at Mount Sinai, New York, NY, USA.
• Int. J. Cardiol. 2017 Sep 15; 243: 132-139.

ObjectivesPercutaneous coronary intervention (PCI) of the left main (LM) or proximal left anterior descending artery (pLAD) is considered high-risk as these segments subtend substantial left ventricular myocardial area. We assessed the patterns and associations between dual antiplatelet therapy (DAPT) cessation and 2-year outcomes in LM/pLAD vs. other PCI from the all-comer PARIS registry.MethodsTwo-year major adverse cardiovascular events (MACE) were a composite of cardiac death, myocardial infarction, definite/probable stent thrombosis or target lesion revascularization. DAPT cessation was predefined as physician-guided permanent discontinuation, temporary interruption, or non-recommended disruption due to non-compliance or bleeding.ResultsOf the study population (n=5018), 25.0% (n=1252) underwent LM/pLAD PCI and 75.0% (n=3766) PCI to other segments. Compared to others, LM/pLAD patients presented with fewer comorbidities, less frequent acute coronary syndromes but more multivessel and bifurcation disease treated with greater stent lengths. Two-year adjusted risk of MACE (11.4% vs. 11.6%; HR 1.10, 95% CI 0.90-1.34, p=0.36) was similar between LM/pLAD vs. other patients. DAPT discontinuation was significantly higher (43.3% vs. 39.4%, p=0.01) in LM/pLAD patients with borderline significance for lower disruption (10.0% vs. 14.7%, p=0.059) compared to other patients. DAPT discontinuation was not associated with higher risk of MACE in LM/pLAD (HR 0.65, 95% CI 0.34-1.25) or other PCI groups (HR 0.67, 95% CI 0.47-0.95).ConclusionsLM/pLAD PCI was not an independent predictor of 2-year MACE. Compared to other PCI, patients undergoing LM/pLAD PCI had higher rates of physician recommended DAPT discontinuation, however, discontinuation did not result in greater adverse events.Copyright © 2017 Elsevier B.V. All rights reserved.

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