International Circulation: What do you think that PARIS adds to the conversation on Dual Anti-Platelet Therapy (DAPT)?
Dr. Roxana Mehran: As the principle investigator， I have an obvious conflict of interest regarding PARIS， and it may be good to talk to other. However， for the very first time， we have a novel finding in thinking of DAPT not as an on-and-off switch by rather what was the circumstance by which the switch was turned off or why did it go back on. We collected that data prospectively， not retrospectively in large registry of real-world patients. We found that different modes of adherence have different outcomes on the patients and different implications. For example， if you abruptly stopped DAPT without physician guidance， there is a higher rate of major clinical events. Under physician guidance， even with earlier interruption or discontinuation， was not associated with important clinical outcomes. It brings back confidence that if a cardiologist is closely monitoring the case， guiding the patient through their options， outcomes can turn out well. Importantly， PARIS included a larger number of second-generation drug eluting stents that are， in general， safer than first generation. I think that is an caveat regarding PARIS. This is a contemporary approach because， in this current generation of drug-eluting stents， we are seeing low event rates and when you reduce， stop， or interrupt under the guidance of a physician， you’ll be ok. That is an important message that has not been seen before and we are going to follow this out for two years.
《国际循环》：您认为PARIS试验对双联抗血小板疗法（DAPT）的讨论有什么影响？
Mehran教授：作为首席研究员，我谈论PARIS会有明显的利益冲突。不过，这是第一个试验探讨DAPT在什么样的情况下要停止，什么情况下要恢复，而不仅仅将DAPT作为一种可停可续的方法。这个注册研究在真实世界患者中，前瞻性地而不是回顾性地收集数据。我们发现不同模式的依从性的结果不同，意义也不同。例如，如果患者在没有医生指导下，突然停止DAPT，主要临床事件的发生率升高很多。但在医生指导下，即使早期中断DAPT，临床结果也没有什么变化。我们有信心说如果心脏科医生密切监督指导患者减用或停用DAPT，仍会有好的临床结果。PARIS研究大量使用的是第二代的DES，总体来说优于第一代的DES，这可能是原因之一。我们看到，当代的DES事件发生率较低，当患者在医生指导下减量、停止或中断DAPT时，患者会没事。这种情形以往从未得到报道，我们将持续随访2年。
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