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Late Clinical Events After Clopidogrel Discontinuation May Limit the Benefit of Drug-Eluting Stents

An Observational Study of Drug-Eluting Versus Bare-Metal Stents

Matthias Pfisterer, MD, FACC^_*,_*, Hans Peter Brunner-La Rocca, MD^_*, Peter T. Buser, MD, FACC^_*, Peter Rickenbacher, MD, Patrick Hunziker, MD, Christian Mueller, MD, Raban Jeger, MD^_*, Franziska Bader, RN^_*, Stefan Osswald, MD, FACC^_*, Christoph Kaiser, MD^_* for the BASKET-LATE Investigators

^_* Department of Cardiology, University Hospital, Basel, Switzerland
Department of Intensive Care Medicine, University Hospital, Basel, Switzerland
Department of Internal Medicine, University Hospital, Basel, Switzerland
Bruderholzspital, Basel, Switzerland

View larger version (26K): [in this window] [in a new window] [Download PPT slide]   Figure 1 Patient flow chart. Note that 746 of 826 patients (90.3%) surviving the initial 6 months without major cardiac events were enrolled. Follow-up regarding survival was complete in 743 of 746 patients (99.6%), whereas 10 patients were alive and well but did not consent to detailed information. BMS = bare-metal stent; DES = drug-eluting stent.

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 2 Late major cardiac events (months 7 to 18). Note that the primary focus of this observation, cardiac death or nonfatal myocardial infarction (MI), was significantly greater in drug-eluting stent (red) versus bare-metal stent (blue) groups, which contrasts with a trend toward a lower restenosis-related target vessel revascularization (TVR) rate after drug-eluting stents.

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 3 Cardiac death/myocardial infarction (MI) and restenosis-related target vessel revascularization (TVR) after drug-eluting (DES) versus bare-metal stent (BMS) implantation. Comparison of the occurrence of cardiac death/nonfatal MI (A and C) and the need for "restenosis-related" target vessel revascularization (TVR, B and D) after DES (red) versus BMS (blue) implantation. Note that in this graph, the initial 30-day events that are not related to drug-eluting properties of the stents are included (A and B, period 0 to 18 months) or disregarded (C and D, period 1 to 18 months).

View larger version (26K): [in this window] [in a new window] [Download PPT slide]   Figure 4 Late stent thrombosis and related clinical events. Late angiographically documented stent thrombosis and thrombosis-related clinical events for drug-eluting (red) versus bare-metal (blue) stent-treated patients. Note the overall low rates with formally nonsignificant differences but consistent findings of these events.

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 5 Timing of late thrombotic events after clopidogrel discontinuation. Red = drug-eluting stent; blue = bare-metal stent.