Abstract 2218: Can High Clopidogrel Compliance Post Drug-eluting Stent Implantation be Obtained and What is the Impact on Stent Thrombosis?
Background: Stent thrombosis, although uncommon, appears to be more frequent with drug-eluting stent (DES) than bare metal stent implantation. Early clopidogrel cessation is recognized to be an independent predictor of DES thrombosis. It is widely accepted that this drug be continued for at least 12 months. The aim of this study was to assess the rates of clopidogrel compliance in a large tertiary center with unrestricted DES use.
Methods: We analyzed 6255 patients (pts) who underwent percutaneous coronary intervention (PCI) with DES implantation at our institution since April 2003. We conduct periodic clinical follow-up on all pts up to 1 year post initial DES implantation. Additionally, we analyzed two subgroups: all pts who presented with an acute ST elevation myocardial infarction (STEMI) (757 pts) and all pts who presented with acute coronary syndrome (ACS) (2202 pts). All pts were discharged on dual antiplatelet therapy for a minimum of 12 months clopidogrel with detailed instructions on the importance of long-term antiplatelet compliance.
Results: In the overall population the mean age was 64.4 ± 12.4 years, there were 66.2% male, and 34.3% with diabetes mellitus. The overall clopidogrel compliance ranges from 94.6% at 3 months to 79.1% at 12 months. (Chart) At our institution the overall thrombosis rate associated with clopidogrel cessation was 31.6% with an overall thrombosis rate of 1.9% for the Cypher stent and 0.9% for the Taxus stent.
Conclusions: A high compliance rate of long-term clopidogrel use can be obtained, but this is not prohibitive of stent thrombosis. Factors other than clopidogrel cessation should be studied in order to minimize this devastating complication.