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Open Access Highly Accessed Research article

Duration of dual antiplatelet therapy following percutaneous coronary intervention on re-hospitalization for acute coronary syndrome

Shih-Chin Chen1, Fei-Yuan Hsiao123*, Chii-Ming Lee4, William Wei-Yuan Hsu56 and Churn-Shiouh Gau178*

Author Affiliations

1 Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, 33, Linsen South Road, Taipei, Taiwan

2 School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan

3 Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan

4 Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan

5 Department of Computer Science and Engineering, National Taiwan Ocean University, Keelung, Taiwan

6 Institute of Information Science, Academia Sinica, Taipei, Taiwan

7 Center for Drug Evaluation, 3F, No. 465, Zhongxiao E. Rd. Sec. 6, Taipei, Taiwan

8 Food and Drug Administration, Ministry of Health and Welfare, Taipei, Taiwan

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BMC Cardiovascular Disorders 2014, 14:21  doi:10.1186/1471-2261-14-21

Published: 18 February 2014

Abstract

Background

The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) remains uncertain. The objective of this study was to examine the association between duration of dual antiplatelet therapy and re-hospitalization for acute coronary syndrome (ACS) in ACS patients who underwent PCI.

Methods

We identified 975 newly diagnosed ACS patients who underwent PCI between July, 2007 and June, 2009, at a medical center in Taiwan. Cox proportional hazard models were used to examine the association between duration of dual antiplatelet therapy (9 months, 12 months and 15 months) and risks of re-hospitalization for ACS.

Results

At a mean follow-up of 2.3 years, we found that use of clopidogrel for ≥ 12 months was associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.59, 95% CI 0.36-0.95; p = 0.03). However, use of clopidogrel for ≥ 15 months was not associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.57, 95% CI 0.29-1.13; p = 0.11). Similar results were found in patients who implanted drug-eluting stents (DES), for whom at least 12 months of clopidogrel therapy is especially critical.

Conclusion

The benefit of ≥ 12 months of clopidogrel use in reducing the risk of re-hospitalization for ACS was significant among ACS patients who underwent PCI and was especially critical for those who implanted DES.

Keywords:
Acute coronary syndrome (ACS); Percutaneous coronary intervention (PCI); Clopidogrel; Dual antiplatelet therapy; Drug eluting stent (DES)