Thim, Troels5; Johansen, Martin Berg2; Chisholm, Gro Egholm5; Schmidt, Morten5; Kaltoft, Anne5; Sørensen, Henrik Toft5; Thuesen, Leif5; Kristensen, Steen Dalby5; Bøtker, Hans Erik5; Krusell, Lars Romer5; Lassen, Jens Flensted5; Thayssen, Per5; Jensen, Lisette Okkels5; Tilsted, Hans-Henrik1; Maeng, Michael6
1 Aalborg University Hospital, The Faculty of Medicine, Aalborg University, VBN2 The Faculty of Medicine, Aalborg University, VBN3 Klinik Hjerte-Lunge, The Faculty of Medicine, Aalborg University, VBN4 Hjertemedicin (Kardiologi), The Faculty of Medicine, Aalborg University, VBN5 unknown6 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
An observational study
BACKGROUND: The impact of adherence to the recommended duration of dual antiplatelet therapy after first generation drug-eluting stent implantation is difficult to assess in real-world settings and limited data are available. METHODS: We followed 4,154 patients treated with coronary drug-eluting stents in Western Denmark for 1 year and obtained data on redeemed clopidogrel prescriptions and major adverse cardiovascular events (MACE, i.e., cardiac death, myocardial infarction, or stent thrombosis) from medical databases. RESULTS: Discontinuation of clopidogrel within the first 3 months after stent implantation was associated with a significantly increased rate of MACE at 1-year follow-up (hazard ratio (HR) 2.06; 95% confidence interval (CI): 1.08-3.93). Discontinuation 3-6 months (HR 1.29; 95% CI: 0.70-2.41) and 6-12 months (HR 1.29; 95% CI: 0.54-3.07) after stent implantation were associated with smaller, not statistically significant, increases in MACE rates. Among patients who discontinued clopidogrel, MACE rates were highest within the first 2 months after discontinuation. CONCLUSIONS: Discontinuation of clopidogrel was associated with an increased rate of MACE among patients treated with drug-eluting stents. The increase was statistically significant within the first 3 months after drug-eluting stent implantation but not after 3 to 12 months.