The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents
Background
The optimal duration of clopidogrel use for prevention of stent thrombosis with drug-eluting stent (DES) use is uncertain. Our objective was to determine whether the planned duration of clopidogrel at the time of percutaneous coronary intervention affected patient outcomes.
Methods
We analyzed data from 2,980 patients who underwent percutaneous coronary intervention in the Melbourne Interventional Group registry who had 12-month follow-up. We compared outcomes at 30 days and 12 months according to planned duration of clopidogrel use.
Results
Twelve-month mortality was significantly lower in patients with a DES with a longer (≥12 months) planned duration of clopidogrel when compared with a shorter (≤6 months) planned duration (2.8% vs 5.3%, P = .012). However, myocardial infarction, target-vessel revascularization, and overall major adverse cardiac events were similar in the longer- and shorter-duration clopidogrel strategies. In contrast, in patients receiving a bare-metal stent, mortality at 12 months was similar among the clopidogrel-duration strategies. Kaplan-Meier analysis demonstrated improved cumulative survival with planned clopidogrel use of ≥12 months (log rank P = .017), and the propensity score–adjusted odds ratio was 0.59 (95% confidence interval 0.35-0.99, P = .04). Premature cessation of clopidogrel in DES patients was documented in 5.2% of patients alive at 30-day follow-up, and these patients had increased 12-month mortality (10.6% vs 1.4%, P < .0001) and major adverse cardiac events (22.4% vs 12.0%, P = .005).
Conclusions
These data suggest that in patients treated with DES, longer (≥12 months) planned duration of clopidogrel results in reduced 12-month mortality and that premature cessation of clopidogrel results in significantly higher event rates. Randomized studies are urgently needed to address this issue.
aDepartment of Cardiology at the Alfred Hospital, Melbourne, Victoria, Australia
bDepartment of Cardiology at the Royal Melbourne Hospital, Melbourne, Victoria, Australia
cDepartment of Cardiology at the Austin Hospital, Melbourne, Victoria, Australia
dDepartment of Epidemiology and Preventative Medicine, Centre for Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Victoria, Australia
eDepartment of Cardiology at the Box Hill Hospital, Melbourne, Victoria, Australia
fDepartment of Cardiology at the Geelong Hospital, Geelong, Victoria, Australia
gDepartment of Cardiology at the Frankston Hospital, Melbourne, Victoria, Australia
Reprint requests: Stephen J. Duffy, MB, BS, PhD, Heart Centre, Alfred Hospital, Commercial Road, Melbourne 3004, Victoria, Australia.
ABSTRACT