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

Rikke Sørensen,Peter R Hansen,Lars Køber,Christian Torp-Pedersen,Gunnar H Gislason,Henrik E Poulsen,Ulrik Abildgaard,Fredrik Folke,Morten L Hansen,Jan K Madsen,Peter Weeke,Emil L Fosbøl,Steen Z Abildstrom

doi:10.1186/1471-2261-10-6

Abstract

BackgroundThe 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.MethodsUsing 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.ResultsThe 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).ConclusionsWe 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.

Highlights

The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear
The landmark analyses showed no differences in death, recurrent myocardial infarction (MI) or the combined endpoint, when comparing the 2002-2003 regimen with the 2004-2005 regimen among patients treated with PCI Day 0-1
The PCI-CURE trial revealed a superior effect of combined treatment with aspirin and clopidogrel vs. aspirin in non-ST-elevation MI/acute coronary syndrome patients treated with PCI

Summary

Introduction

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. In the past 5 years there has been a clear tendency to recommend increased duration of clopidogrel treatment. The benefit of clopidogrel may decline with time, but the risk of bleeding remains; further studies of the optimal length of treatment are warranted. In Denmark, the length of clopidogrel treatment has followed the change in guidelines, increasing from 6 months in 2002-2003 to 12 months after 2004[10]. We conducted a nationwide study of 11680 PCI treated patients with acute myocardial infarction (MI) to evaluate additional benefit (death or recurrent MI) and safety (bleedings) from the increased duration of clopidogrel treatment

Methods

Results

Discussion

Conclusion