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Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study.

Sørensen R, Abildstrom SZ, Weeke P, Fosbøl EL, Folke F, Hansen ML, Hansen PR, Madsen JK, Abildgaard U, Køber L, Poulsen HE, Torp-Pedersen C, Gislason GH - BMC Cardiovasc Disord (2010)

Bottom Line: The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints.We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel.The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. rs@heart.dk

ABSTRACT

Background: The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear. We studied the risk of death or recurrent myocardial infarction (MI) in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI.

Methods: Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens.

Results: The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference) for the composite endpoint of 1.01 (confidence intervals 0.81-1.26) and 1.24 (confidence intervals 0.95-1.62) for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06).

Conclusions: We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

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Related in: MedlinePlus

Persistence with clopidogrel treatment.
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Figure 1: Persistence with clopidogrel treatment.

Mentions: Use of clopidogrel was defined as a dispensed prescription within 30 days of discharge (ATC code B01AC04). Mean length of treatment was 172.8 days (standard deviation 133.2) in 2002-2003 and 319.7 days (standard deviation 72.0) in 2004-2005, calculated from the proportions of days covered[10]. Subdivision in treatment periods, with corresponding variance of treatment duration of 6-months and 12-months treatment, respectively, is referred to as the 2002-2003 regimen and the 2004-2005 regimen. The persistence with treatment is shown in Figure 1. Information of coverage of clopidogrel tablets on Day 91 and Day 181 after first dispensed prescription of clopidogrel were calculated and used in a sensitivity analysis.


Duration of clopidogrel treatment and risk of mortality and recurrent myocardial infarction among 11 680 patients with myocardial infarction treated with percutaneous coronary intervention: a cohort study.

Sørensen R, Abildstrom SZ, Weeke P, Fosbøl EL, Folke F, Hansen ML, Hansen PR, Madsen JK, Abildgaard U, Køber L, Poulsen HE, Torp-Pedersen C, Gislason GH - BMC Cardiovasc Disord (2010)

Persistence with clopidogrel treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2837608&req=5

Figure 1: Persistence with clopidogrel treatment.
Mentions: Use of clopidogrel was defined as a dispensed prescription within 30 days of discharge (ATC code B01AC04). Mean length of treatment was 172.8 days (standard deviation 133.2) in 2002-2003 and 319.7 days (standard deviation 72.0) in 2004-2005, calculated from the proportions of days covered[10]. Subdivision in treatment periods, with corresponding variance of treatment duration of 6-months and 12-months treatment, respectively, is referred to as the 2002-2003 regimen and the 2004-2005 regimen. The persistence with treatment is shown in Figure 1. Information of coverage of clopidogrel tablets on Day 91 and Day 181 after first dispensed prescription of clopidogrel were calculated and used in a sensitivity analysis.

Bottom Line: The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints.We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel.The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. rs@heart.dk

ABSTRACT

Background: The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear. We studied the risk of death or recurrent myocardial infarction (MI) in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI.

Methods: Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens.

Results: The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference) for the composite endpoint of 1.01 (confidence intervals 0.81-1.26) and 1.24 (confidence intervals 0.95-1.62) for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06).

Conclusions: We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.

Show MeSH
Related in: MedlinePlus