Abstract
BackgroundThe optimal duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) remains uncertain. The objective of this study was to examine the association between duration of dual antiplatelet therapy and re-hospitalization for acute coronary syndrome (ACS) in ACS patients who underwent PCI.MethodsWe identified 975 newly diagnosed ACS patients who underwent PCI between July, 2007 and June, 2009, at a medical center in Taiwan. Cox proportional hazard models were used to examine the association between duration of dual antiplatelet therapy (9 months, 12 months and 15 months) and risks of re-hospitalization for ACS.ResultsAt a mean follow-up of 2.3 years, we found that use of clopidogrel for ≥ 12 months was associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.59, 95% CI 0.36-0.95; p = 0.03). However, use of clopidogrel for ≥ 15 months was not associated with a decreased risk of re-hospitalization for ACS (adjusted HR 0.57, 95% CI 0.29-1.13; p = 0.11). Similar results were found in patients who implanted drug-eluting stents (DES), for whom at least 12 months of clopidogrel therapy is especially critical.ConclusionThe benefit of ≥ 12 months of clopidogrel use in reducing the risk of re-hospitalization for ACS was significant among ACS patients who underwent PCI and was especially critical for those who implanted DES.
Highlights
The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) remains uncertain
Findings from the PCI subpopulation of the Clopidogrel in Unstable Angina to Prevent Recurrent Events (PCI-CURE) [3] trial suggested that 3-12 months duration of clopidogrel treatment after PCI significantly reduced the risk of cardiovascular death, myocardial infarction and stroke
Of the 2,641 patients newly hospitalized for acute coronary syndrome (ACS) between July 1, 2007 and June 30, 2009, we identified 1,382 patients who underwent PCI
Summary
The optimal duration of dual antiplatelet therapy after percutaneous coronary intervention (PCI) remains uncertain. The objective of this study was to examine the association between duration of dual antiplatelet therapy and re-hospitalization for acute coronary syndrome (ACS) in ACS patients who underwent PCI. The clinical benefits of clopidogrel in combination with aspirin in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) have been well demonstrated [1,2,3,4]. The optimal treatment duration of dual antiplatelet therapy following PCI remains uncertain. The conflict between the reimbursement policy and latest clinical guidelines may further reflect urgent needs for more evidence on the minimal necessary duration of dual antiplatelet therapy for ACS patients
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