Impact of early versus late clopidogrel discontinuation on stent thrombosis following percutaneous coronary intervention with first- and second-generation drug-eluting stents.

MedStar author(s):
Citation: American Journal of Cardiology. 113(12):1968-76, 2014 Jun 15.PMID: 24767975Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Angioplasty, Balloon, Coronary/ae [Adverse Effects] | *Coronary Stenosis/dt [Drug Therapy] | *Drug-Eluting Stents/ae [Adverse Effects] | *Graft Occlusion, Vascular/et [Etiology] | *Thrombosis/et [Etiology] | *Ticlopidine/aa [Analogs & Derivatives] | *Withholding Treatment | Aged | Aged, 80 and over | Angioplasty, Balloon, Coronary/mt [Methods] | Cohort Studies | Combined Modality Therapy | Coronary Angiography/mt [Methods] | Coronary Stenosis/mo [Mortality] | Coronary Stenosis/ra [Radiography] | Coronary Stenosis/th [Therapy] | Dose-Response Relationship, Drug | Drug Administration Schedule | Female | Follow-Up Studies | Graft Occlusion, Vascular/mo [Mortality] | Graft Occlusion, Vascular/pp [Physiopathology] | Hospital Mortality | Humans | Male | Middle Aged | Paclitaxel/pd [Pharmacology] | Prosthesis Failure/de [Drug Effects] | Registries | Retrospective Studies | Severity of Illness Index | Sirolimus/aa [Analogs & Derivatives] | Sirolimus/pd [Pharmacology] | Survival Analysis | Ticlopidine/ad [Administration & Dosage] | Time Factors | Treatment OutcomeLocal holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: Premature antiplatelet therapy discontinuation (ATD) after drug-eluting stent (DES) implantation is known to predict stent thrombosis (ST). However, recent data suggest that a shorter antiplatelet therapy duration is safe with newer generation DESs. The study aimed to compare the impact of early and late clopidogrel ATDs on ST in a real-world registry of first- and second-generation DES use. A total of 6,236 patients who underwent DES implantation were analyzed retrospectively: 4,217 received first-generation DESs (sirolimus- and paclitaxel-eluting stents) and 2,019 received second-generation DESs (everolimus-eluting stents). Within each DES cohort, patients were categorized into timing of clopidogrel discontinuation within 1 year: early (<3 months), late (3 to 12 months), and continued. ST rates and clinical outcomes at 1 year were analyzed. There were 341 patients (8.1%) in the first-generation DES group and 126 patients (6.2%) in the second-generation DES group who discontinued clopidogrel within the first year. Definite and probable ST rates were 3.8% for early ATD, 2.5% for late ATD, and 0.5% for continued (p = 0.001) in the first-generation DES cohort, whereas there were no definite or probable ST events in early and late ATDs and 0.5% for continued in the second-generation DES cohort. Major adverse cardiac event rates were 9.9% for early ATD, 5.6% for late ATD, and 0.9% for continued (p <0.001) in the first-generation DES cohort and 5.5% for early ATD, 7.4% for late ATD, and 1.5% for continued (p <0.001) in the second-generation DES cohort. In conclusion, ATD within the first year is associated with increased ST events with first-generation DESs, whereas ATD appears safe with second-generation DESs with regard to ST. However, ATD is associated with greater mortality and major adverse cardiac events in both first- and second-generation DESs. Thus, this study supports ATD if required based on physician discretion with the use of second-generation DESs but cannot rule out potential benefit for longer duration of dual antiplatelet therapy even when second-generation DESs are used. Copyright 2014 Elsevier Inc. All rights reserved.All authors: Chen F, Loh JP, Omar A, Pendyala LK, Pichard AD, Satler LF, Torguson R, Waksman RDigital Object Identifier: Date added to catalog: 2014-08-21
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article Available 24767975

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

Premature antiplatelet therapy discontinuation (ATD) after drug-eluting stent (DES) implantation is known to predict stent thrombosis (ST). However, recent data suggest that a shorter antiplatelet therapy duration is safe with newer generation DESs. The study aimed to compare the impact of early and late clopidogrel ATDs on ST in a real-world registry of first- and second-generation DES use. A total of 6,236 patients who underwent DES implantation were analyzed retrospectively: 4,217 received first-generation DESs (sirolimus- and paclitaxel-eluting stents) and 2,019 received second-generation DESs (everolimus-eluting stents). Within each DES cohort, patients were categorized into timing of clopidogrel discontinuation within 1 year: early (<3 months), late (3 to 12 months), and continued. ST rates and clinical outcomes at 1 year were analyzed. There were 341 patients (8.1%) in the first-generation DES group and 126 patients (6.2%) in the second-generation DES group who discontinued clopidogrel within the first year. Definite and probable ST rates were 3.8% for early ATD, 2.5% for late ATD, and 0.5% for continued (p = 0.001) in the first-generation DES cohort, whereas there were no definite or probable ST events in early and late ATDs and 0.5% for continued in the second-generation DES cohort. Major adverse cardiac event rates were 9.9% for early ATD, 5.6% for late ATD, and 0.9% for continued (p <0.001) in the first-generation DES cohort and 5.5% for early ATD, 7.4% for late ATD, and 1.5% for continued (p <0.001) in the second-generation DES cohort. In conclusion, ATD within the first year is associated with increased ST events with first-generation DESs, whereas ATD appears safe with second-generation DESs with regard to ST. However, ATD is associated with greater mortality and major adverse cardiac events in both first- and second-generation DESs. Thus, this study supports ATD if required based on physician discretion with the use of second-generation DESs but cannot rule out potential benefit for longer duration of dual antiplatelet therapy even when second-generation DESs are used. Copyright 2014 Elsevier Inc. All rights reserved.

English

Powered by Koha