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| |  Clopidogrel Helps Reduce Mortality in Patients With Diabetes After Stent Implantation: Presented at SCAI By Thomas S. May ORLANDO, FL -- May 11, 2007 -- Extended use of clopidogrel helps reduce the incidence of death and myocardial infarction (MI) in patients with diabetes after implantation of either bare metal or drug eluting stents, according to research presented here at the 30th Annual Scientific Sessions of the Society for Cardiovascular Angiography and Interventions (SCAI). "There is concern that drug-eluting stents are associated with late adverse events, such as death and [MI] secondary to stent thrombosis," said lead researcher Somjot Brar, MD, fellow, division of cardiology, Kaiser Permanente, UCLA, Los Angeles, California, United States. To date, no data have been available to date on outcomes in diabetics -- a group at high risk for complications, Dr. Brar pointed out. To determine if rates of death or MI differ between bare metal stents (BMS) and drug-eluting stents (DES) by duration of clopidogrel use in a diabetic population, Dr. Brar and colleagues identified 749 individuals with diabetes who underwent stent implantation from 2002-2005. At six months, 219 BMS patients and 443 DES patients survived and were event-free from MI. These subjects were then divided into four groups, depending on stent type and whether they used clopidogrel for less than 6 months (clopidogrel nonusers) or beyond six month (continued users). Clopidogrel use was determined using pharmacy prescription records. At one-year, rates of survival free of MI in the DES group was 97.8% among clopidogrel continued users and 94.4% among clopidogrel nonusers (P =.06). For BMS, it was 96.6% with clopidogrel and 87.8% without clopidogrel (P =.01). "This is the first large study in patients with diabetes followed for late adverse clinical outcomes after percutaneous coronary intervention by stent type," Dr. Brar noted. "Our data show that drug eluting stents are not associated with an increase in death or MI in diabetic patients," he added. Dr. Brar also emphasised that continued clopidogrel use is important, since noncompliance with therapy has been identified as the strongest predictor of stent thrombosis. "Two prior landmark analyses have shown that the incidence of death and MI is lower with a bare metal stent at 6 to 18 months, compared to drug eluting stents among clopidogrel nonusers in the general [percutaneous coronary intervention] population. Our data show that clopidogrel use beyond 6 months decreased events in both the BMS and DES groups." These data indicate that it is important to continue clopidogrel treatment for an extended period following stent implantation, Dr. Brar noted. He admitted, however, that the appropriate duration of clopidogrel therapy remains to be determined. Funding for this study was provided by Kaiser Permanente and Boston Scientific Corporation.
[Presentation title: Clopidogrel Use and Death/MI after Stent Implantation in a Diabetic Population. Abstract O-8]
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