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 a...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Journal Article |
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Mosby, INC
2009
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| Online Access: | http://hdl.handle.net/20.500.11937/18570 |
| _version_ | 1848749782981410816 |
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| author | Butler, M. Eccleston, D. Clark, D. Ajani, A. Andrianopoulos, N. Brennan, A. New, G. Black, A. Szto, G. Reid, Christopher Yan, B. Shaw, J. Dart, A. Duffy, S. |
| author_facet | Butler, M. Eccleston, D. Clark, D. Ajani, A. Andrianopoulos, N. Brennan, A. New, G. Black, A. Szto, G. Reid, Christopher Yan, B. Shaw, J. Dart, A. Duffy, S. |
| author_sort | Butler, M. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. © 2009 Mosby, Inc. |
| first_indexed | 2025-11-14T07:26:25Z |
| format | Journal Article |
| id | curtin-20.500.11937-18570 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T07:26:25Z |
| publishDate | 2009 |
| publisher | Mosby, INC |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-185702017-09-13T13:44:34Z The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents Butler, M. Eccleston, D. Clark, D. Ajani, A. Andrianopoulos, N. Brennan, A. New, G. Black, A. Szto, G. Reid, Christopher Yan, B. Shaw, J. Dart, A. Duffy, S. 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. © 2009 Mosby, Inc. 2009 Journal Article http://hdl.handle.net/20.500.11937/18570 10.1016/j.ahj.2009.02.018 Mosby, INC restricted |
| spellingShingle | Butler, M. Eccleston, D. Clark, D. Ajani, A. Andrianopoulos, N. Brennan, A. New, G. Black, A. Szto, G. Reid, Christopher Yan, B. Shaw, J. Dart, A. Duffy, S. The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title | The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title_full | The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title_fullStr | The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title_full_unstemmed | The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title_short | The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| title_sort | effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents |
| url | http://hdl.handle.net/20.500.11937/18570 |