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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

^_* Departments of Cardiology
Intensive Care Medicine
Internal Medicine, University Hospital
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.