Clopidogrel discontinuation within the first year after coronary drug-eluting stent implantation: an observational study
1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
2 Department of Clinical Epidemiology, Aarhus University Hospital, Brendstrupgaardsvej 100, Aarhus, N 8200, Denmark
3 Department of Cardiology, Odense University Hospital, Odense, Denmark
4 Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
BMC Cardiovascular Disorders 2014, 14:100 doi:10.1186/1471-2261-14-100Published: 13 August 2014
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.
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.
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.
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.