12-months of clopidogrel treatment provided no significant benefit in reducing the composite of death or recurrent myocardial infarction compared to 6-months of treatment (HR 1.01).
Cohort (n=11,680)
Yes
Does a 12-month clopidogrel regimen reduce the risk of death or recurrent myocardial infarction compared to a 6-month regimen in patients with myocardial infarction treated with percutaneous coronary intervention?
In a real-world cohort of MI patients treated with PCI, extending clopidogrel treatment from 6 to 12 months did not significantly reduce the risk of death or recurrent MI.
Effect estimate: HR 1.01 (95% CI 0.81-1.26)
BACKGROUND: The optimal duration of clopidogrel treatment after percutaneous coronary intervention (PCI) is unclear. We studied the risk of death or recurrent myocardial infarction (MI) in relation to 6- and 12-months clopidogrel treatment among MI patients treated with PCI. METHODS: Using nationwide registers of hospitalizations and drug dispensing from pharmacies we identified 11 680 patients admitted with MI, treated with PCI and clopidogrel. Clopidogrel treatment was categorized in a 6-months and a 12-months regimen. Rates of death, recurrent MI or a combination of both were analyzed by the Kaplan Meier method and Cox proportional hazards models. Bleedings were compared between treatment regimens. RESULTS: The Kaplan Meier analysis indicated no benefit of the 12-months regimen compared with the 6-months in all endpoints. The Cox proportional hazards analysis confirmed these findings with hazard ratios for the 12-months regimen (the 6-months regimen used as reference) for the composite endpoint of 1.01 (confidence intervals 0.81-1.26) and 1.24 (confidence intervals 0.95-1.62) for Day 0-179 and Day 180-540 after discharge. Bleedings occurred in 3.5% and 4.1% of the patients in the 6-months and 12-months regimen (p = 0.06). CONCLUSIONS: We found comparable rates of death and recurrent MI in patients treated with 6- and 12-months' clopidogrel. The potential benefit of prolonged clopidogrel treatment in a real-life setting remains uncertain.
Sørensen et al. (2010) conducted a cohort in Myocardial infarction treated with percutaneous coronary intervention (n=11,680). Clopidogrel (12-months regimen) vs. Clopidogrel (6-months regimen) was evaluated on Composite of death or recurrent myocardial infarction (Day 0-179) (HR 1.01, 95% CI 0.81-1.26). 12-months of clopidogrel treatment provided no significant benefit in reducing the composite of death or recurrent myocardial infarction compared to 6-months of treatment (HR 1.01).