TY - BOOK AU - Chen, Fang AU - Loh, Joshua P AU - Omar, Alfazir AU - Pendyala, Lakshmana K AU - Pichard, Augusto D AU - Satler, Lowell F AU - Torguson, Rebecca AU - Waksman, Ron TI - Impact of early versus late clopidogrel discontinuation on stent thrombosis following percutaneous coronary intervention with first- and second-generation drug-eluting stents SN - 0002-9149 KW - *Angioplasty, Balloon, Coronary/ae [Adverse Effects] KW - *Coronary Stenosis/dt [Drug Therapy] KW - *Drug-Eluting Stents/ae [Adverse Effects] KW - *Graft Occlusion, Vascular/et [Etiology] KW - *Thrombosis/et [Etiology] KW - *Ticlopidine/aa [Analogs & Derivatives] KW - *Withholding Treatment KW - Aged KW - Aged, 80 and over KW - Angioplasty, Balloon, Coronary/mt [Methods] KW - Cohort Studies KW - Combined Modality Therapy KW - Coronary Angiography/mt [Methods] KW - Coronary Stenosis/mo [Mortality] KW - Coronary Stenosis/ra [Radiography] KW - Coronary Stenosis/th [Therapy] KW - Dose-Response Relationship, Drug KW - Drug Administration Schedule KW - Female KW - Follow-Up Studies KW - Graft Occlusion, Vascular/mo [Mortality] KW - Graft Occlusion, Vascular/pp [Physiopathology] KW - Hospital Mortality KW - Humans KW - Male KW - Middle Aged KW - Paclitaxel/pd [Pharmacology] KW - Prosthesis Failure/de [Drug Effects] KW - Registries KW - Retrospective Studies KW - Severity of Illness Index KW - Sirolimus/aa [Analogs & Derivatives] KW - Sirolimus/pd [Pharmacology] KW - Survival Analysis KW - Ticlopidine/ad [Administration & Dosage] KW - Time Factors KW - Treatment Outcome KW - MedStar Heart & Vascular Institute KW - Comparative Study KW - Journal Article N1 - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006 N2 - 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 UR - http://dx.doi.org/10.1016/j.amjcard.2014.03.041 ER -