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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

Landmark analyses using the Kaplan Meier Methods for patients with PCI on day 2-29. Patients event-free on Day 180 were included in the second analysis.
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Figure 4: Landmark analyses using the Kaplan Meier Methods for patients with PCI on day 2-29. Patients event-free on Day 180 were included in the second analysis.

Mentions: Results of the landmark analyses are shown in Figure 3 and 4. The landmark analyses showed no differences in death, recurrent MI or the combined endpoint, when comparing the 2002-2003 regimen with the 2004-2005 regimen among patients treated with PCI Day 0-1. Likewise, the landmark analyses among patients treated invasively on Day 2-29 showed no differences in rates of death or combined endpoint. For recurrent MI there was a reduced occurrence among patients treated during 2004-2005 within the first 180 days of treatment (p = 0.05).


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)

Landmark analyses using the Kaplan Meier Methods for patients with PCI on day 2-29. Patients event-free on Day 180 were included in the second analysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Landmark analyses using the Kaplan Meier Methods for patients with PCI on day 2-29. Patients event-free on Day 180 were included in the second analysis.
Mentions: Results of the landmark analyses are shown in Figure 3 and 4. The landmark analyses showed no differences in death, recurrent MI or the combined endpoint, when comparing the 2002-2003 regimen with the 2004-2005 regimen among patients treated with PCI Day 0-1. Likewise, the landmark analyses among patients treated invasively on Day 2-29 showed no differences in rates of death or combined endpoint. For recurrent MI there was a reduced occurrence among patients treated during 2004-2005 within the first 180 days of treatment (p = 0.05).

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