1 / 18

Clopidogrel Use and Death/MI After Stent Implantation in a Diabetic Population

SCAI ‘07. Clopidogrel Use and Death/MI After Stent Implantation in a Diabetic Population. Results from the SUNSET registry. Somjot S. Brar , Simerjeet K. Brar, John Kim, Ray Zadegan, Michael Ree, In-lu A. Liu, Prakash Mansukhani, Vicken Aharonian, Ric Hyett, Albert Y-J. Shen.

nan
Download Presentation

Clopidogrel Use and Death/MI After Stent Implantation in a Diabetic Population

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SCAI ‘07 Clopidogrel Use and Death/MI After Stent Implantation in a Diabetic Population Results from the SUNSET registry Somjot S. Brar, Simerjeet K. Brar, John Kim, Ray Zadegan, Michael Ree, In-lu A. Liu, Prakash Mansukhani, Vicken Aharonian, Ric Hyett, Albert Y-J. Shen Department of Cardiology Kaiser Permanente, Los Angeles & UCLA School of Medicine Kaiser Permanente

  2. Disclosures • Research grant support from Boston Scientific • S. Brar, MD • A. Shen, MD Kaiser Permanente

  3. Background • Death / MI reportedly increased with DES compared to BMS. • Two prior landmark analysis show increased death / MI in DES compared to BMS. • BASKET-LATE • Eisenstein et al. • Limited data in patients with diabetes. • Duration of clopidogrel after PCI remains unknown.

  4. Study Questions • Is death / MI influenced by: • Clopidogrel duration? • Stent type (DES, BMS)? • Among patients taking clopidogrel for ≤ 6 months, is death / MI more frequent with DES compared to BMS? Kaiser Permanente

  5. Methods • Study date: January 2002 – December 2005 • Study type: observational using the SUNSET registry • Population: • consecutive diabetic patients undergoing first PCI • No prior PCI or CABG • Multiple stent types not permitted • Insured members of a prepaid integrated health plan • Location: high volume tertiary care referral center (Los Angeles, CA) • Main outcomemeasure: death or MI at 18 months (545 days) post PCI Kaiser Permanente

  6. Methods • Clopidogrel • pharmacy prescription records • Duration of clopidogrel calculated from index PCI • User: >6 months of clopidogrel use from index PCI date • Non-users: ≤6 months of use from the index PCI date • “Landmark” analysis • Excluded patients with events within first 6 months • Similar to an observational analysis from BASKET-LATE. Kaiser Permanente

  7. Study Flow 749 diabetics underwent first revascularization Exclusion: 41 Death/MI/Revascularization 37 Clopidogrel usage unknown 671 event free from Death or MI at 6 months F/U to 18 months post PCI Kaiser Permanente

  8. Four Study Groups: Stratified by Stent Type & Clopidogrel 671 Patients Clopidogrel / Stent type BMS (n=221) DES (n=450) Clopidogrel (-) N=74 Clopidogrel (+) N=147 Clopidogrel (-) N=127 Clopidogrel (+) N=323 Death or MI (18 months) Kaiser Permanente

  9. Baseline Characteristics

  10. Baseline Characteristics

  11. Death / MI by Stent type(0d – 18mo) 20 20 p=0.05 15 15 Cumulative Incidence (%) 10 10 5 5 0 0 No. at Risk DES 498 469 459 320 BMS 251 237 225 218

  12. Death / MI by Stent Type(6mo – 18mo) 10 p=0.08 6.2% Cumulative Incidence (%) 5 3.1% 0

  13. Death / MI in BMS group(6mo – 18mo) 20 p=0.01 12.2% Cumulative Incidence (%) 10 3.5% 0

  14. Death / MI in DES group(6mo – 18mo) 20 p=0.07 10 Cumulative Incidence (%) 5.5% 2.2% 0

  15. Death / MI in Clopidogrel Non-Users (6mo – 18mo) 30 p=0.11 20 Cumulative Incidence (%) 12.2% 10 5.5% 0

  16. Death / MI by Clopidogrel Duration(6mo – 18mo) 20 <9 months (n=314) 9-12 months (n=207) >12 months (n=150) 10 Cumulative Incidence (%) 7.3% (64% DES) p=0.0005 2.0% (69% DES) (71% DES) 1.0% 0 p= 0.27

  17. Discussion • From index PCI date to 18 months, death / MI less with DES vs. BMS (p=0.05). • Landmark Analysis • Clopidogrel use was associated with less death / MI in both DES (p=0.07) and BMS groups (p=0.01). • Among clopidogrel non-users, death / MI less with DES vs. BMS (p=0.11). • Death / MI less with 9-12 mo and >12 mo. of clopidogrel use compared to ≤ 9 mo (p < 0.001). • Clopidogrel compliance by Rx records was 95% Kaiser Permanente

  18. Conclusion • Extended clopidogrel use ( >6 mo) from the index PCI was associated with less death / MI in both DES and BMS groups. • Overall trend towards less death / MI in the DES group compared to the BMS group. • Among clopidogrel non-users, no difference in death / MI by stent type. Kaiser Permanente

More Related