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Association of clopidogrel treatment with risk of mortality and cardiovascular events following myocardial infarction
Charlotte Andersson1, Stig Lyngbæk, Cu Dinh Nguyen
1Department of Cardiology, Gentofte Hospital, Niels Andersens vej 65, 2900 Hellerup, Denmark. ca@heart.dk
JAMA
|September 6, 2012
Summary
Clopidogrel treatment after myocardial infarction (MI) shows reduced effectiveness in patients with diabetes compared to those without. This indicates a need for alternative antiplatelet strategies in diabetic populations post-MI.
Area of Science:
- Cardiology
- Pharmacology
- Diabetology
Background:
- High platelet reactivity is common in diabetic patients despite clopidogrel use.
- Clinical trials show limited benefit of clopidogrel in diabetic patients compared to non-diabetic patients.
Purpose of the Study:
- To evaluate the clinical effectiveness of clopidogrel in patients with diabetes after myocardial infarction (MI).
Main Methods:
- Individual-level data linkage of Danish nationwide administrative registries (2002-2009).
- Follow-up of patients hospitalized with incident MI for up to 1 year.
- Analysis using Cox proportional-hazard and propensity score-matched models, adjusting for multiple covariates.
Main Results:
- Clopidogrel showed less effectiveness in reducing all-cause mortality (HR 0.89 vs 0.75) and cardiovascular mortality (HR 0.93 vs 0.77) in patients with diabetes compared to those without.
- Propensity score-matched models yielded similar results, confirming the reduced effectiveness.
- No significant difference in effectiveness for the composite endpoint of recurrent MI and all-cause mortality was observed (P for interaction, .08).
Conclusions:
- Clopidogrel treatment after MI is associated with a lower risk reduction for all-cause and cardiovascular death in patients with diabetes compared to those without diabetes.
- Findings suggest potential limitations of conventional clopidogrel therapy in diabetic patients post-MI.
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