Abstract 4605: Prolonged Use of Clopidogrel Reduces Death and Myocardial Infarction Following Drug Eluting Stent but Not Bare Metal Stent Placement: The VA DES Study
The use of clopidogrel and ASA has been recommended for up to one year after DES placement but the value beyond this time is controversial. To evaluate this issue, all patients in the VA healthcare system that received a stent from 2002–2006 had baseline, follow-up and pharmacy data collected. We estimated crude and adjusted hazard ratios for death, MI, revascularization, and major bleeding up to 4 years using Cox proportional hazards modeling and propensity analysis including adjustment for clopidogrel use beyond 6 mo. Landmark analysis was done for use more than 3, 6, 12, 18 and 24 mos. Of 44,390 pts who received a stent, 31,824 had either a DES or BMS, and did not have prior clopidogrel use. 84% had HTN, 45% DM, 24% PVD. Compared to BMS pts (15,001), DES pts (15,592) had more hypertension, DM, renal failure, and PVD. Nearly all pts were on beta blockers (98%) and lipid lowering drugs (99%). 44% of DES pts and 23%. BMS pts were on clopidogrel >12mo. In the DES group, propensity adjusted death and death or MI was better with more than 3, 6, 12, 18 and 24 month use of clopidogrel. In the BMS group no difference was seen after 3 mo. For death or MI and >12mo clopidogrel with DES HR=0.83 (0.75–0.93) and with BMS HR=1.0(0.91–1.1). No differences were seen for major bleeding or repeat revascularization in either group. In conclusion, in this large unrestricted veteran population, prolonged clopidogrel use reduced death and death or MI in DES and but not BMS patients. These data suggest prolonged use beyond 12 months should be considered in patients with DES and high risk characteristics similar to this population.