Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation Eric Eisenstein, DBA; Kevin Anstrom,

Slides:

Advertisements

Similar presentations

MAIN-COMPARE Study Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease.

Advertisements

Decline in the Use of Drug-Eluting Stents for Patients With NSTEMI Undergoing PCI: Results From the CRUSADE and ACTION Registries Matthew T. Roe, Christopher.

PCI - A prospective, randomized, double- blind substudy of patients undergoing PCI in the CURE trial.

SCAAR: Lower late and very late stent thrombosis rates with new generation drug eluting stents compared to bare metal stents Christoph Varenhorst M.D Ph.D;

Comparison of the New Mayo Clinic Risk Scores and Clinical SYNTAX Score in Predicting Adverse Cardiovascular Outcomes following Percutaneous Coronary Intervention.

Clopidogrel Use and Death/MI After Stent Implantation in a Diabetic Population Somjot S. Brar, Simerjeet K. Brar, John Kim, Ray Zadegan, Michael Ree, In-lu.

Can we prevent stent restenosis after coronary stent implantation

FFR vs Angiography for Multivessel Evaluation

Final Three-Year Outcome of a Randomized Trial Comparing Second Generation Drug-eluting Stents Using Either Biodegradable Polymer or Durable Polymer The.

TRial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet InhibitioN with Prasugrel TRITON-TIMI 38 TRITON-TIMI 38 Elliott M. Antman, MD.

ISAR-LEFT MAIN 2 Randomized Trial Zotarolimus- vs. Everolimus-Eluting Stents for Treatment of Unprotected Left Main Coronary Artery Lesions Julinda Mehilli,

PCI VS CABG JOURNAL REVIEW

Clinical Trial Results. org Pexelizumab for Acute ST-Elevation Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention.

University Medical Center Groningen Thrombus aspiration during primary PCI FZ Thrombus Aspiration during Percutaneous coronary intervention in Acute.

Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE) Trial Basel Stent Cost-effectiveness Trial-Late Thrombotic Events (BASKET LATE)

COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Purpose To compare the efficacy of optimal medical therapy (OMT)

Drug-Eluting Stent Mortality Meta-Analysis Presented at European Society of Cardiology Scientific Congress, September 2006 Presented by Dr. Alain J. Nordmann.

Published in Circulation 2005 Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease: A Meta-Analysis Demosthenes.

1 1 The Use of Percutaneous Coronary Intervention in Patients with Class I Indications for Coronary Artery Bypass Graft Surgery: Data from the National.

SCAAR UCR SWEDEN 2007 Stefan James, Jörg Carlsson, Johan Lindbäck, Tage Nilsson, Ulf Stenestrand, Lars Wallentin and Bo Lagerqvist for the SCAAR study.

ACUTE CORONARY SYNDROMES:

Prasugrel vs. Clopidogrel for Acute Coronary Syndromes Patients Managed without Revascularization — the TRILOGY ACS trial On behalf of the TRILOGY ACS.

A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial A Pooled Analysis of the REAL-LATE and the ZEST-LATE Trial Seung-Jung Park, MD, PhD, University.

Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty Study (ARMYDA-2) Trial ARMYDA-2 Trial Presented at The American College of Cardiology.

ARMYDA-4 (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty) study Prospective, multicenter, randomized, double blind trial investigating.

Impact of Drug-Eluting Stents on Revascularization Choices in Patients with Acute Coronary Syndromes and Multivessel Coronary Disease: Results from the.

Arterial Revascularization Therapies Part II: a non- randomized comparison of contemporary PCI and coronary artery bypass grafting (CABG) in patients with.

Tarunjit Singh Department of Internal Medicine Westchester Medical Center New York Medical College Valhalla NY.

Long Term Clinical Outcomes Following Drug-Eluting and Bare Metal Stenting in Massachusetts Laura Mauri, MD, MSc; Treacy Silverstein, B.Sc.; Ann Lovett,

Clinical Trial Results. org Randomized Comparison of a High Clopidogrel Maintenance Dose in Patients with Diabetes Mellitus and Coronary Artery Disease:

Bleeding in Patients Undergoing Percutaneous Coronary Interventions: A Risk Model From 302,152 Patients in the NCDR. Sameer K. Mehta MD, Andrew D. Frutkin.

Left Main Trifurcation Disease: Early and Long-Term Outcomes Of Percutaneous Coronary Intervention I.Sheiban, A.Gerasimou, F. Sciuto, P.Omedè, G. Biondi.

TAXUS Landmark Analysis Impact of Long-Term Clopidogrel Usage on Death, Myocardial Infarction and Stent Thrombosis Gregg W. Stone, MD Stephen G. Ellis,

TAXUS ATLAS Trial Presented at The EuroPCR meeting Paris, France May 2006 Presented by Dr. Mark Turco TAXUS ATLAS 9-Month Results: Evaluation of TAXUS.

PRODIGY Objective Study Design Primary Composite Endpoint

Clinical Trial Results. org Increased Risk in Patients with High Platelet Aggregation Receiving Chronic Clopidogrel Therapy Undergoing Percutaneous Coronary.

CARDIOLOGIA INV 1 CAREGGI - FIRENZE Objective To determine whether nonresponsiveness to clopidogrel as revealed by high in vitro residual platelet reactivity.

Basel Stent Cost-Effectiveness (BASKET) Trial BASKET Trial Presented at The European Society of Cardiology Hotline Session 2005 Presented by Dr. Matthias.

LONG-TERM OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION FOR UNPROTECTED LEFT MAIN CORONARY ARTERY DISEASE: INITIAL CLINICAL EXPERIENCE. Graidis Ch. 1,

6/9/2008 Comparative effectiveness reviews: methodological observations David B. Matchar, MD Professor of Medicine and Director, Center for Clinical Health.

Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial PEACE Trial Presented at The American Heart Association Scientific Sessions.

LONG-TERM CLINICAL OUTCOMES AFTER REPEAT DRUG-ELUTING STENT IMPLANTATION FOR IN DRUG-ELUTING STENT RESTENOSIS. C. Graidis, D. Dimitriadis, A. Ntatsios,

Bangalore S, et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308(13): ?

Clinical Experience with the Bio Active Stent (BAS) in FINLAND 9 e CFCI Hotel Meridien Etoile Paris, France 10 Octobre 2007 Pasi Karjalainen, MD, PhD.

? What more will it take to turn the tide of treatment for angina patients from a PCI-first to an optimal medical therapy– first approach? 1.

- Published online December 23, 2008 DOI: /S (08) Study sponsored and funded by Assistance Publique.

Allen Jeremias, Neal Kleiman, Deborah Nassif, Wen-Hua Hsieh, Michael Pencina, Kelly Maresh, Manish Parikh, Donald Cutlip, Ron Waksman, Steven Goldberg,

ISAR-CABG Objective To compare the efficacy of DES with BMS in a randomized trial powered for clinical events Sample 610 patients with de novo SVG lesions.

Gender Differences in Long-Term Outcomes Following PCI of Patients with Non-ST Elevation ACS: Results from the ACUITY Trial Alexandra J. Lansky on behalf.

M. Valgimigli, MD, PhD University of Ferrara, ITALY On behalf of the PRODIGY Investigators PROlonging Dual antiplatelet treatment after Grading stent-induced.

Antiplatelet Therapy Use after Discharge among Acute Myocardial Infarction Patients with In-hospital Bleeding Tracy Y. Wang, MD, MHS, Lan Xiao, PhD, Karen.

Antiplatelet Therapy for Reduction of Myocardial Damage During Angioplasty Study (ARMYDA-2) Trial ARMYDA-2:ARMYDA-2:

Is there any role for intravascular ultrasound in bifurcation lesions? Giuseppe Biondi-Zoccai, MD University of Turin, Turin, Italy.

Gregg W. Stone MD for the ACUITY Investigators A Prospective, Randomized Trial of Bivalirudin in Acute Coronary Syndromes Final One-Year Results from the.

Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.

The GREAT Trial. The Grampian Region Early Anistreplase Trial Reference Zahringer M, Sapoval M, Pattynama PM, et al. Sirolimus-eluting versus bare-metal.

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Long-Term Outcomes of Older Diabetic Patients After.

Results From the MISSION! Intervention Study Sirolimus-Eluting Stents Vs Bare-Metal Stents in Patients With STEMI : 9-Month Angiographic and Intravascular.

Trial to Assess the Use of the Cypher Stent in Acute Myocardial Infarction Treated with Balloon Angioplasty (TYPHOON) Trial Presented at The American College.

Statins The AURORA Trial Reference Fellstrom BC. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med. 2009;360. A.

Prof. Dr. Sigmund Silber, FESC, FACC On behalf of the RESOLUTE

NORSTENT Trial design: Patients with obstructive coronary artery disease were randomized to a drug-eluting stent (DES) (n = 4,504) versus a bare-metal.

LONG-DES II Trial Randomized Comparison of the Efficacy of Sirolimus-Eluting Stent Versus Paclitaxel-Eluting Stent in the Treatment of Long Native Coronary.

POISE-2 PeriOperative ISchemic Evaluation-2 Trial

Bern-Rotterdam Registry Published in the Lancet

Antiplatelet Therapy Use after Discharge among Acute Myocardial Infarction Patients with In-hospital Bleeding Tracy Y. Wang, MD, MHS, Lan Xiao, PhD, Karen.

The American College of Cardiology Presented by Dr. Raimund Erbel

Global Registry of Acute Coronary Events: GRACE

Late Thrombosis in Drug Eluting Stents (DES)

IVUS-XPL Trial design: Patients undergoing drug-eluting stent implantation for long coronary lesions were randomized to IVUS-guided PCI (n = 700) vs. angiography-guided.

Presentation transcript:

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation Eric Eisenstein, DBA; Kevin Anstrom, PhD; David Kong, MD; Linda Shaw, MS; Robert Tuttle, MSPH; Daniel Mark, MD, MPH; Judith Kramer, MD, MS; Robert Harrington, MD; David Matchar, MD; David Kandzari, MD; Eric Peterson, MD, MPH; Kevin Schulman, MD; Robert Califf, MD Published in JAMA January 10, 2007 Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Background Instructions for the use of drug-eluting stents (DES) commercially available in the U.S. specify treatment with clopidogrel for at least 3 months (for sirolimus-coated stents) or 6 months (for paclitaxel-coated stents) after implantationInstructions for the use of drug-eluting stents (DES) commercially available in the U.S. specify treatment with clopidogrel for at least 3 months (for sirolimus-coated stents) or 6 months (for paclitaxel-coated stents) after implantation However, studies of late thrombosis events among patients with DES have cast doubt on whether the recommended regimens are sufficientHowever, studies of late thrombosis events among patients with DES have cast doubt on whether the recommended regimens are sufficient This study assessed the association between clopidogrel use and long-term rates of death and death or MI following initial percutaneous coronary intervention (PCI) with DES or bare-metal stents (BMS)This study assessed the association between clopidogrel use and long-term rates of death and death or MI following initial percutaneous coronary intervention (PCI) with DES or bare-metal stents (BMS) Instructions for the use of drug-eluting stents (DES) commercially available in the U.S. specify treatment with clopidogrel for at least 3 months (for sirolimus-coated stents) or 6 months (for paclitaxel-coated stents) after implantationInstructions for the use of drug-eluting stents (DES) commercially available in the U.S. specify treatment with clopidogrel for at least 3 months (for sirolimus-coated stents) or 6 months (for paclitaxel-coated stents) after implantation However, studies of late thrombosis events among patients with DES have cast doubt on whether the recommended regimens are sufficientHowever, studies of late thrombosis events among patients with DES have cast doubt on whether the recommended regimens are sufficient This study assessed the association between clopidogrel use and long-term rates of death and death or MI following initial percutaneous coronary intervention (PCI) with DES or bare-metal stents (BMS)This study assessed the association between clopidogrel use and long-term rates of death and death or MI following initial percutaneous coronary intervention (PCI) with DES or bare-metal stents (BMS) Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Study Design Landmark analysis used, and two landmarks were used in this study:Landmark analysis used, and two landmarks were used in this study: –Starting at 6-months following PCI onward –Starting at 12-months following PCI onward At the 6-month and 12-month landmark times, the patients were divided into four groups for analysis: DES with clopidogrel, DES without clopidogrel, BMS with clopidogrel, and BMS without clopidogrel.At the 6-month and 12-month landmark times, the patients were divided into four groups for analysis: DES with clopidogrel, DES without clopidogrel, BMS with clopidogrel, and BMS without clopidogrel. Outcomes for these groups were evaluated up to 24 months after initial PCI procedure.Outcomes for these groups were evaluated up to 24 months after initial PCI procedure. Landmark analysis used, and two landmarks were used in this study:Landmark analysis used, and two landmarks were used in this study: –Starting at 6-months following PCI onward –Starting at 12-months following PCI onward At the 6-month and 12-month landmark times, the patients were divided into four groups for analysis: DES with clopidogrel, DES without clopidogrel, BMS with clopidogrel, and BMS without clopidogrel.At the 6-month and 12-month landmark times, the patients were divided into four groups for analysis: DES with clopidogrel, DES without clopidogrel, BMS with clopidogrel, and BMS without clopidogrel. Outcomes for these groups were evaluated up to 24 months after initial PCI procedure.Outcomes for these groups were evaluated up to 24 months after initial PCI procedure. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug- Eluting Stent Implantation: Study Design  Outcomes analyzed for Death, Nonfatal MI, and Death or MI DESn=1,501DESn=1,501BMSn=3,165BMSn=3,165 4,666 patients undergoing PCI with BMS or DES Prospective. Landmark analysis (starting at 6 or 12 mos after PCI). Follow-up at 12, 18, and up to 24-mos. Exclusion Criteria: prior CABG surgery or PCI procedure, significant (>75% stenosis) left main coronary artery disease, interventions other than stent placement during PCI 4,666 patients undergoing PCI with BMS or DES Prospective. Landmark analysis (starting at 6 or 12 mos after PCI). Follow-up at 12, 18, and up to 24-mos. Exclusion Criteria: prior CABG surgery or PCI procedure, significant (>75% stenosis) left main coronary artery disease, interventions other than stent placement during PCI Eisenstein et al. JAMA Jan 10; 297 (2): 159 – mos. follow-up Stent type at Baseline 6 mos. Landmark Analysis DESn=1,216DESn=1,216 BMSn=2,393BMSn=2,393 Clopidogreln=637Clopidogreln=637 No Clopidogrel n=579 n=579 n=1,976 n=1,976 Clopidogreln=416Clopidogreln=416

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug- Eluting Stent Implantation: Study Design  Outcomes analyzed for Death, Nonfatal MI, and Death or MI DESn=1,501DESn=1,501BMSn=3,165BMSn=3,165 4,666 patients undergoing PCI with BMS or DES Prospective. Landmark analysis (starting at 6 or 12 mos after PCI). Follow-up at 12, 18, and up to 24-mos. Exclusion Criteria: prior CABG surgery or PCI procedure, significant (>75% stenosis) left main coronary artery disease, interventions other than stent placement during PCI 4,666 patients undergoing PCI with BMS or DES Prospective. Landmark analysis (starting at 6 or 12 mos after PCI). Follow-up at 12, 18, and up to 24-mos. Exclusion Criteria: prior CABG surgery or PCI procedure, significant (>75% stenosis) left main coronary artery disease, interventions other than stent placement during PCI Eisenstein et al. JAMA Jan 10; 297 (2): 159 – mos. follow-up Stent type at Baseline 12 mos. Landmark Analysis DESn=528DESn=528 BMSn=1,990BMSn=1,990 Clopidogreln=252Clopidogreln=252 No Clopidogrel n=276 n=276 n=1,644 n=1,644 Clopidogreln=326Clopidogreln=326

Clinical Trial Results. org Characteristic DES w/ Clop. (n=637 ) Clop. (n=637 ) DES w/o Clop (n=579) BMS w/ Clop.(n=417) BMS w/o Clop. (n= 1,976) P for Trend Age, Median (IQR) 61 (53-71) 60 (53-70) 61 (53-70) 61 (52-71) 0.73 Black race (%) 121 (19.0) 137 (23.7) 82 (19.7) 395 (20.0) 0.18 Male Sex (%) 398 (62.5) 368 (63.6) 266 (63.8) 1,233 (62.4) 0.93 History of Diabetes (%) 171 (26.8) 171 (29.5) 121 (29.0) 449 (22.7) History of CHF (%) 60 (9.6) 82 (14.5) 38 (9.3) 208 (11.0) 0.03 History of MI (%) 247 (38.8) 221 (38.2) 213 (51.1) 913 (46.2) <0.001 No of Diseased Vessels (58.1) 186 (29.2) 81 (12.7) 356 (61.5) 178 (30.7) 45 (7.8) 275 (65.9) 109 (26.1) 33 (7.9) 1,331 (67.4) 531 (26.9) 114 (5.8) <0.001 Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Baseline Characteristics for 6 mos. patients Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Characteristic DES w/ Clop. (n=637 ) DES w/o Clop (n=579) BMS w/ Clop.(n=417) BMS w/o Clop. (n=1,976 ) P for Trend Income, median $ In thousands <0.001 Avg House Val, $ In thousands Aspirin use at 6 mos. 6 mos. 12 mos. 12 mos. 24 mos. 24 mos. 600 (94.2) 478 (91.2) 179 (93.2) 430 (74.3) 371 (86.3) 148 (85.6) 360 (86.3) 335 (84.0) 304 (82.2) 1583 (80.1) 1569 (85.0) 1541 (87.1) < Clop. use at 6 mos. 6 mos. 12 mos. 12 mos. 24 mos. 24 mos. 637 (100) 382 (72.9) 106 (55.2) 0 (0) 64 (14.9) 25 (14.5) 417 (100) 309 (77.4) 230 (62.2) 0 (0) 93 (5.0) 143 (8.1) <0.001<0.001<0.001 Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Baseline Characteristics for 6 mos. patients Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Characteristic DES w/ Clop. (n=252 ) DES w/o Clop (n=276) BMS w/ Clop.(n=346) BMS w/o Clop. (n=1,644 ) P for Trend Age, Median (IQR) 61 (53-70) 62 (53-72) 0.76 Black race (%) 36 (14.3) 62 (22.5) 69 (19.9) 310 (18.9) 0.12 Male Sex (%) 164 (65.1) 170 (61.6) 204 (59.0) 1,031 (62.7) 0.45 History of Diabetes (%) 69 (27.4) 79 (28.6) 109 (31.5) 364 (22.1) <0.001 History of CHF (%) 25 (10.0) 27 (10.0) 29 (8.5) 163 (10.0) 0.87 History of MI (%) 95 (37.7) 94 (34.1) 170 (49.1) 745 (45.3) <0.001 No of Diseased Vessels (57.1) 78 (31.0) 30 (11.9) 173 (62.7) 83 (30.1) 20 (7.3) 223 (64.5) 98 (28.3) 25 (7.2) 1,130 (68.7) 427 (26.0) 87 (5.3) <0.001 Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Baseline Characteristics for 12-mos. Patients Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Characteristic DES w/ Clop. (n=252 ) DES w/o Clop (n=276) BMS w/ Clop.(n=346) BMS w/o Clop. (n=1,644 ) P for Trend Income, median $ In thousands Avg House Val, $ In thousands Aspirin use at 6 mos. 6 mos. 12 mos. 12 mos. 24 mos. 24 mos. 223 (88.5) 234 (92.9) 140 (94.0) 235 (85.1) 236 (85.5) 151 (86.8) 277 (80.1) 295 (85.3) 257 (81.1) 1373 (83.5) 1398 (85.0) 1360 (88.1) <0.001 Clop. use at 6 mos. 6 mos. 12 mos. 12 mos. 24 mos. 24 mos. 218 (86.5) 252 (100) 104 (69.8) 68 (24.6) 0 (0) 14 (8.1) 271 (78.3) 346 (100) 221 (69.7) 74 (4.5) 0 (0) 85 (5.5) <0.001<0.001<0.001 Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Baseline Characteristics for 12-mos. Patients Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Main Outcome Measures Endpoint (%) Endpoint (%) Adjusted outcomes were analyzed at 24 monthsAdjusted outcomes were analyzed at 24 months Patients in the DES with clop. group had significantly lower rates of death than did patients in the DES without clopidogrel groupPatients in the DES with clop. group had significantly lower rates of death than did patients in the DES without clopidogrel group Among BMS patients, there were no differences in deathAmong BMS patients, there were no differences in death No difference was observed in nonfatal MINo difference was observed in nonfatal MI Difference=-3.3±3 p=0.03 Difference=-0.7±2.1 p =0.50 Adjusted rates of Death for Analysis Starting at 6-months Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Main Outcome Measures Endpoint (%) Endpoint (%) Adjusted outcomes were analyzed at 24 monthsAdjusted outcomes were analyzed at 24 months Patients in the DES with clop. group had significantly lower rates of death or MI than did patients in the DES without clopidogrel groupPatients in the DES with clop. group had significantly lower rates of death or MI than did patients in the DES without clopidogrel group Among BMS patients, there were no differences in death or MIAmong BMS patients, there were no differences in death or MI Difference=-4.1±3.5 p 0.02 Difference=-0.5±2.7 p=0.70 Adjusted rates of Death or MI Starting at 6 mos. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Main Outcome Measures Endpoint (%) Endpoint (%) Adjusted outcomes were analyzed at 24 monthsAdjusted outcomes were analyzed at 24 months Patients in the DES with clop. group had significantly lower rates of death than did patients in the DES without clopidogrel groupPatients in the DES with clop. group had significantly lower rates of death than did patients in the DES without clopidogrel group Among BMS patients, there were no differences in deathAmong BMS patients, there were no differences in death Difference=-3.5±2.4 p=0.004 Difference=0.6±2.1 p=0.57 Adjusted rates of Death for Analysis Starting at 12-mos. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Main Outcome Measures Endpoint (%) Endpoint (%) Adjusted outcomes were analyzed at 24 monthsAdjusted outcomes were analyzed at 24 months Patients in the DES with clop. group had significantly lower rates of death or MI than did patients in the DES without clopidogrel groupPatients in the DES with clop. group had significantly lower rates of death or MI than did patients in the DES without clopidogrel group Among BMS patients, there were no differences in death or MIAmong BMS patients, there were no differences in death or MI Difference=-4.5±2.6 p<0.001 Difference=1.0±2.6 p=0.44 Adjusted rates of Death or MI Analysis Starting at 12-mos. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Limitations Clopidogrel use was not randomly assigned; thus, the decision to continue the drug beyond the periods recommended by the relevant clinical trials may have been correlated with unmeasured prognostic factors.Clopidogrel use was not randomly assigned; thus, the decision to continue the drug beyond the periods recommended by the relevant clinical trials may have been correlated with unmeasured prognostic factors. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Limitations Clopidogrel use in this analysis was identified by patient report at 2 discrete points (6- and 12-month follow-up). Therefore, these data are subject to recall bias.Clopidogrel use in this analysis was identified by patient report at 2 discrete points (6- and 12-month follow-up). Therefore, these data are subject to recall bias. Furthermore, the indications and rationale for long- term clopidogrel regimens and for its discontinuations were not collected.Furthermore, the indications and rationale for long- term clopidogrel regimens and for its discontinuations were not collected. Clopidogrel use in this analysis was identified by patient report at 2 discrete points (6- and 12-month follow-up). Therefore, these data are subject to recall bias.Clopidogrel use in this analysis was identified by patient report at 2 discrete points (6- and 12-month follow-up). Therefore, these data are subject to recall bias. Furthermore, the indications and rationale for long- term clopidogrel regimens and for its discontinuations were not collected.Furthermore, the indications and rationale for long- term clopidogrel regimens and for its discontinuations were not collected. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Limitations The 24-month event rates of 0% for death, nonfatal MI, and death or MI for the DES with clopidogrel group in the 12- month landmark analysis may underestimate the true event rates. However, 14 patients receiving DES died or had a nonfatal MI, and none of these 14 patients was in the DES with clopidogrel group.The 24-month event rates of 0% for death, nonfatal MI, and death or MI for the DES with clopidogrel group in the 12- month landmark analysis may underestimate the true event rates. However, 14 patients receiving DES died or had a nonfatal MI, and none of these 14 patients was in the DES with clopidogrel group. Extended clopidogrel therapy has its own risks and this analysis does not evaluate the long-term nonfatal implications of its use.Extended clopidogrel therapy has its own risks and this analysis does not evaluate the long-term nonfatal implications of its use. The 24-month event rates of 0% for death, nonfatal MI, and death or MI for the DES with clopidogrel group in the 12- month landmark analysis may underestimate the true event rates. However, 14 patients receiving DES died or had a nonfatal MI, and none of these 14 patients was in the DES with clopidogrel group.The 24-month event rates of 0% for death, nonfatal MI, and death or MI for the DES with clopidogrel group in the 12- month landmark analysis may underestimate the true event rates. However, 14 patients receiving DES died or had a nonfatal MI, and none of these 14 patients was in the DES with clopidogrel group. Extended clopidogrel therapy has its own risks and this analysis does not evaluate the long-term nonfatal implications of its use.Extended clopidogrel therapy has its own risks and this analysis does not evaluate the long-term nonfatal implications of its use. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.

Clinical Trial Results. org Clopidogrel Use and Long-term Clinical Outcomes After Drug-Eluting Stent Implantation: Summary In a large consecutive cohort of contemporary patients receiving PCI, the long-term risk for death and major cardiac events was significantly increased among patients in the DES group who had discontinued clopidogrel therapy at 6 or 12 months.In a large consecutive cohort of contemporary patients receiving PCI, the long-term risk for death and major cardiac events was significantly increased among patients in the DES group who had discontinued clopidogrel therapy at 6 or 12 months. Extended-duration clopidogrel therapy following DES implantation was associated with a lower incidence of death or MI, a finding that has immediate implications for clinical practice.Extended-duration clopidogrel therapy following DES implantation was associated with a lower incidence of death or MI, a finding that has immediate implications for clinical practice. In a large consecutive cohort of contemporary patients receiving PCI, the long-term risk for death and major cardiac events was significantly increased among patients in the DES group who had discontinued clopidogrel therapy at 6 or 12 months.In a large consecutive cohort of contemporary patients receiving PCI, the long-term risk for death and major cardiac events was significantly increased among patients in the DES group who had discontinued clopidogrel therapy at 6 or 12 months. Extended-duration clopidogrel therapy following DES implantation was associated with a lower incidence of death or MI, a finding that has immediate implications for clinical practice.Extended-duration clopidogrel therapy following DES implantation was associated with a lower incidence of death or MI, a finding that has immediate implications for clinical practice. Eisenstein et al. JAMA Jan 10; 297 (2): 159 – 68.