Abstract 13139: Decline in Clopidogrel Discontinuation Rates and its Association with Mortality after Acute Myocardial Infarction
Introduction: While clopidogrel is recommended for 12 months after percutaneous coronary intervention (PCI) with drug eluting stents (DES) for acute myocardial infarction (AMI), we found in a prior study that clopidogrel discontinuation (CD) occurred commonly within 30 days of hospital discharge and was associated with rehospitalization and mortality. Whether recent increased awareness of the importance of clopidogrel has translated into improved adherence is unknown.
Methods: We examined 2114 AMI patients treated with DES enrolled in the multicenter PREMIER (years 2003–2004, n= 549) and TRIUMPH (years 2004–2008, n=1565) AMI registries. The primary outcome variable was CD and a secondary outcome was 1-year mortality, which was examined using Kaplan-Meier and Cox regression analyses (adjusted for age and site).
Results: Among 2114 AMI patients undergoing PCI with DES in both registries (25% diabetics, 32% females, mean age 59 ± 12 years, mean DES stents used 1.6 ± 0.9), CD within the first 30 days after PCI with DES declined from 13.8% in PREMIER registry to 5.4% in the contemporary TRIUMPH registry (p<0.001, Figure A). Despite an improvement in CD rates over time, premature CD in the TRIUMPH registry was associated with a trend towards increased 1-year mortality (HR 2.6 (95% CI 0.7–9.2), p=0.14) while CD was strongly associated with 1-year mortality in PREMIER (HR 7.78 (95% CI 1.7–36.4), p=0.009) (Figure B).
Conclusions: Early clopidogrel discontinuation rates among AMI patients treated with DES have declined dramatically over time, yet there remains a higher risk of mortality for those stopping clopidogrel prematurely. Further efforts to minimize early CD through education or better patient selection for DES are important.
- © 2010 by American Heart Association, Inc.