Comparison of the Impact of Short (&lt;1 Year) and Long-Term (≥1 Year) Clopidogrel Use Following Percutaneous Coronary Intervention on Mortality

Banerjee, Subhash; Varghese, Cyril; Samuel, Jepsin; Weideman, Rick; Little, Bertis B.; Kelly, Kevin C.; Rao, Sunil V.; Reilly, Robert F.; Brilakis, Emmanouil S.

doi:10.1016/j.amjcard.2008.06.058

Cited by 30 publications

(22 citation statements)

References 19 publications

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“…Along with several recent observational studies [16-18], our findings support the latest ACC /AHA guideline [6] that a at least 12-months of dual antiplatelet therapy following PCI would be beneficial to ACS patients. We found that, at a mean follow-up of approximately 2 years, 9 months of clopidogrel therapy only provided a marginal benefit in reducing the risk of ACS re-hospitalization (adjusted HR 0.69, 95% CI 0.48-1.00; p = 0.05) while 12 months of clopidogrel use was associated with a 40% reduction of the risk of ACS re-hospitalization (adjusted HR 0.59, 95% CI 0.36-0.95; p = 0.03).…”

Section: Discussionsupporting

confidence: 87%

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

Chen

Hsiao

Lee

et al. 2014

BMC Cardiovasc Disord

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BackgroundThe 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.MethodsWe 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.ResultsAt 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.ConclusionThe 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.

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Section: Discussionsupporting

confidence: 87%

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

Chen

Hsiao

Lee

et al. 2014

BMC Cardiovasc Disord

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“…Elevated initial total cholesterol levels in our study had also a significant relation to MACE rates. PRIAMHO II registry of Aros et al (2006) and other studies (Elwood and Sweetnam, 1979;COMMIT, 2005;De Luca et al, 2006;Banerjee et al, 2008;Bonde et al, 2010) proved that B-blokers, statins, clopidogrel, acetylsalisylic acid and ACE inhibitors prescribed on discharge lowered the mortality and MACE rates of first year, significantly. As these medications were prescribed to all ACS patients of our study in accordance to indications and contraindications, no significant difference was found between medical treatment strategies of MACE and non-MACE groups.…”

Section: Discussionmentioning

confidence: 99%

Relationship between cardiovascular evaluation data on admission and secondary adverse cardiac event rate after acute coronary syndrome

Civan¹,

Özcan²,

Zıyrek³

et al. 2014

jecm

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Article HistoryReceived 30 / 10 / 2013 Accepted 08 / 06 / 2014The current study aimed to investigate the relationship of clinical data with mean platelet volume (MPV) and QT dispersion values on admission of acute coronary syndrome (ACS) patients to the adverse cardiac event rate in a follow-up period of 20 months after discharge. For this purpose demographic and clinical data with corrected QT dispersion on admission and MPV values of 97 consequtive patients with ACS were recorded, retrospectively. Their history of major adverse cardiac event (MACE) in a 20 months period after ACS was obtained from the hospital records, interviews with the attending physicians and telephone calls to patients. Demographic and clinical data with corrected QT dispersion on admission, and MPV values were compared between groups with and without MACE in terms of statistical significance. In our study, diabetesmellitus, left ventricular ejection fraction (EF) and wall motion score index (WMSI), corrected QT dispersion, total cholesterol, LDL, CK-MB and troponin levels were found significantly related to the secondary MACE rate (p values; 0.046, 0.0001, 0.0001, 0.032, 0.024, 0.002 and 0.0001, respectively). No significant relation was detected between groups with and without MACE in terms of conservative medical follow-up and revascularization history (p=0.774). In the comparison of mean MPV values, there was no statistically significant difference between MPV values of patients with MACE (10.4±1.8 fl) and without MACE (10.3±2 fl) (p=0.799). In addition, the subgroup analysis on acute ST-elevation myocardial infarction cases in our study group did not state a significant relationship between MPV values below/above 10.3 fl and MACE rates (p=0.774). Finally, this retrospective study showed that corrected QT dispersion, diabetes, contractile reserve of left ventricule, total and LDL-cholesterol and peak cardiac enzyme values assessed during ACS might predict MACE.

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“…A similar study was conducted in 530 consecutive patients who underwent percutaneous coronary intervention (PCI) (85% received a DES), were free of cardiovascular events for 6 months after PCI, and had follow-up available for >12 months [29]. Clopidogrel was used for !1 year and for <1 year in 341 and 189 patients, respectively.…”

Section: Discontinuation After 1 Yearmentioning

confidence: 99%

Antiplatelet therapy discontinuation following drug‐eluting stent placement: Dangers, reasons, and management recommendations

Moussa

Colombo

2009

Cathet Cardio Intervent

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Drug-eluting stents (DES) have several advantages over bare-metal stents (BMS), including significantly lower target vessel revascularization. However, DES is associated with a higher incidence of late stent thrombosis (ST). Although late ST after DES placement is uncommon (approximately 0.4-0.6%/year), it is catastrophic clinical consequences make it a concern. Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is the standard of care for prevention of ST, and DAT discontinuation is associated with a marked increase in ST risk. These guidelines recommend continuing DAT for > or = 12 months after DES implantation in patients not at high risk for bleeding. Premature DAT discontinuation is common in clinical practice. Therefore, it is imperative that physicians be aware of factors contributing to discontinuation, including cost, patient education, and actual bleeding events, so as to educate their patients about the risks and benefits of continued DAT. This review highlights the risks of premature DAT discontinuation, discusses common reasons for discontinuation, and offers potential solutions to improve adherence.

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Comparison of the Impact of Short (<1 Year) and Long-Term (≥1 Year) Clopidogrel Use Following Percutaneous Coronary Intervention on Mortality

Cited by 30 publications

References 19 publications

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

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

Relationship between cardiovascular evaluation data on admission and secondary adverse cardiac event rate after acute coronary syndrome

Antiplatelet therapy discontinuation following drug‐eluting stent placement: Dangers, reasons, and management recommendations

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