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    The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents

    Access Status
    Fulltext not available
    Authors
    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.
    Date
    2009
    Type
    Journal Article
    
    Metadata
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    Citation
    Butler, M. and Eccleston, D. and Clark, D. and Ajani, A. and Andrianopoulos, N. and Brennan, A. and New, G. et al. 2009. The effect of intended duration of clopidogrel use on early and late mortality and major adverse cardiac events in patients with drug-eluting stents. American Heart Journal. 157 (5): pp. 899-907.
    Source Title
    American Heart Journal
    DOI
    10.1016/j.ahj.2009.02.018
    ISSN
    0002-8703
    School
    Department of Health Policy and Management
    URI
    http://hdl.handle.net/20.500.11937/18570
    Collection
    • Curtin Research Publications
    Abstract

    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.

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