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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Long-Term Outcomes by Clopidogrel Duration and Stent Type in a Diabetic Population With De Novo Coronary Artery Lesions

Somjot S. Brar, MD^_*,_*, John Kim, MD, Simerjeet K. Brar, BS, Ray Zadegan, MD, Michael Ree, BS, In-Lu A. Liu, MS, Prakash Mansukhani, MD, Vicken Aharonian, MD, Ric Hyett, BS and Albert Yuh-Jer Shen, MD^,

^_* Center for Interventional Vascular Therapy, Columbia University Medical Center, New York, New York
Department of Cardiology, Kaiser Permanente, Los Angeles, California
Department of Research and Evaluation, Kaiser Permanente, Pasadena, California
University of California, Los Angeles School of Medicine, Los Angeles, California.

Manuscript received September 12, 2007; revised manuscript received December 12, 2007, accepted January 6, 2008.

^_* Reprint requests and correspondence: Dr. Somjot S. Brar, Center for Interventional Vascular Therapy, Columbia University Medical Center, 161 Fort Washington Avenue, 5th Floor, New York, New York 10032. (Email: SBrar{at}cvri.org).

Objectives: The purpose of this study was to determine whether long-term clinical outcomes differed between bare-metal stents (BMS) and drug-eluting stents (DES) by duration of clopidogrel use among diabetic patients.

Background: There is concern that DES are associated with late adverse events such as death and myocardial infarction (MI) secondary to stent thrombosis. However, data on outcomes in diabetic patients remain limited.

Methods: We identified 749 patients with diabetes mellitus who underwent stent implantation with either BMS (n = 251) or DES (n = 498) from October 2002 to December 2004. We performed survival analysis on the full cohort and on those event-free from death, MI, or repeat revascularization at 6 months (n = 671).

Results: By clopidogrel duration, the event rate for death or MI was 3.2% in the >9-month group, 9.4% in the 6- to 9-month group, and 16.5% in the <6-month group, p < 0.001. For death alone, the event rate was 0.5% in the >9-month group, 4.3% in the 6- to 9-month group, and 10.0% in the <6-month group, p < 0.001. When taking BMS clopidogrel non-users as a referent in the multivariate analysis, the hazard ratio (95% confidence interval [CI]) for death and nonfatal MI for DES clopidogrel users, DES clopidogrel nonusers, and BMS clopidogrel users were: HR 0.22 (95% CI 0.08 to 0.62, p = 0.005), HR 0.39 (95% CI 0.13 to 1.13, p = 0.08), and HR 0.25 (95% CI 0.08 to 0.81, p = 0.02), respectively.

Conclusions: Longer duration of clopidogrel use was associated with a lower incidence of death or MI in both the BMS and DES groups. Among clopidogrel nonusers, the incidence of death/MI or death did not differ by stent type.

Abbreviations and Acronyms   ACEI = angiotensin-converting enzyme inhibitor   ARB = angiotensin II receptor blocker   BMS = bare-metal stent(s)   CABG = coronary artery bypass grafting   DES = drug-eluting stent(s)   PCI = percutaneous coronary intervention

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