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Published on: February 26, 2013
Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational
Troels Thim, Martin Berg Johansen, Gro Egholm Chisholm
1Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. michael.maeng@ki.au.dk.
Insights
Early discontinuation of clopidogrel after drug-eluting stent implantation significantly increases major adverse cardiovascular events (MACE). Adherence to dual antiplatelet therapy duration is crucial for patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Real-world data on dual antiplatelet therapy (DAPT) duration after first-generation drug-eluting stent (DES) implantation is limited.
- Assessing the impact of DAPT adherence in routine clinical practice is challenging.
Purpose of the Study:
- To evaluate the association between clopidogrel discontinuation and major adverse cardiovascular events (MACE) after DES implantation.
- To determine the impact of the timing of clopidogrel discontinuation on MACE rates.
Main Methods:
- A cohort of 4,154 patients treated with DES in Western Denmark was followed for 1 year.
- Data on clopidogrel prescription redemption and MACE (cardiac death, myocardial infarction, stent thrombosis) were collected from medical databases.
Main Results:
- Discontinuation of clopidogrel within 3 months post-stent implantation significantly increased 1-year MACE rates (HR 2.06).
- Discontinuation between 3-12 months showed non-significant increases in MACE (HR 1.29).
- MACE rates were highest within 2 months following clopidogrel discontinuation.
Conclusions:
- Clopidogrel discontinuation is linked to higher MACE rates in DES patients.
- The increased MACE risk is statistically significant for early discontinuation (within 3 months) but not for later discontinuation (3-12 months).
Background:
The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available.
Methods:
We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases.
Results:
Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation.
Conclusions:
Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.
