TY - JOUR
T1 - Prior chronic clopidogrel therapy is associated with increased adverse events and early stent thrombosis
AU - The PLATIS (Platelets and Thrombosis in Sheba) Study Group
AU - Asher, Elad
AU - Fefer, Paul
AU - Sabbag, Avi
AU - Herscovici, Romana
AU - Regev, Ehud
AU - Mazin, Israel
AU - Shlomo, Nir
AU - Zahger, Doron
AU - Atar, Shaul
AU - Hammerman, Haim
AU - Polak, Arthur
AU - Beigel, Roy
AU - Matetzky, Shlomi
N1 - Publisher Copyright:
© Schattauer 2016.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Despite the growing use of clopidogrel, limited data exist regarding the prognostic significance of chronic clopidogrel therapy in patients sustaining acute coronary syndrome (ACS). Our aim was to determine whether patients sustaining ACS while on chronic clopidogrel therapy have a worse prognosis than clopidogrel-naïve patients. A total of 5,386 consecutive ACS patients were prospectively characterised and followed-up for 30 days. Of them, 680 (13%) were treated with clopidogrel prior to the index ACS. Major adverse cardiovascular events (MACE) were defined as death, recurrent ACS, stroke and/or stent thrombosis. Compared with clopidogrel-naïve, chronic clopidogreltreated patients were older (66 ± 12 vs 63 ± 13, respectively; p< 0.01), suffered more from diabetes mellitus, hypertension, dyslipidaemia, prior cardiovascular history, including prior myocardial infarction, revascularisation, coronary artery bypass graft and stroke (p< 0.01 for all), and were less likely to present with ST-elevation myocardial infarction (21% vs 45%; respectively; p < 0.001). Prior clopidogrel therapy was associated with a two-fold increase in in-hospital (1.6% vs 0.6%, respectively; p =0.006) as well as 30-day stent thrombosis (2.2% vs 1.0%, respectively; p=0.007). MACE at 30 days was also higher among chronic clopidogrel-treated compared with clopidogrel- naïve patients [12.3% vs 9.4%, respectively; p< 0.01]. In multivariate log regression analysis chronic clopidogrel treatment was an independent predictor of stent thrombosis [OR=2.6 (95%CI 1.2–5.6), p=0.001]. Patients sustaining ACS while on chronic clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes, including stent thrombosis.
AB - Despite the growing use of clopidogrel, limited data exist regarding the prognostic significance of chronic clopidogrel therapy in patients sustaining acute coronary syndrome (ACS). Our aim was to determine whether patients sustaining ACS while on chronic clopidogrel therapy have a worse prognosis than clopidogrel-naïve patients. A total of 5,386 consecutive ACS patients were prospectively characterised and followed-up for 30 days. Of them, 680 (13%) were treated with clopidogrel prior to the index ACS. Major adverse cardiovascular events (MACE) were defined as death, recurrent ACS, stroke and/or stent thrombosis. Compared with clopidogrel-naïve, chronic clopidogreltreated patients were older (66 ± 12 vs 63 ± 13, respectively; p< 0.01), suffered more from diabetes mellitus, hypertension, dyslipidaemia, prior cardiovascular history, including prior myocardial infarction, revascularisation, coronary artery bypass graft and stroke (p< 0.01 for all), and were less likely to present with ST-elevation myocardial infarction (21% vs 45%; respectively; p < 0.001). Prior clopidogrel therapy was associated with a two-fold increase in in-hospital (1.6% vs 0.6%, respectively; p =0.006) as well as 30-day stent thrombosis (2.2% vs 1.0%, respectively; p=0.007). MACE at 30 days was also higher among chronic clopidogrel-treated compared with clopidogrel- naïve patients [12.3% vs 9.4%, respectively; p< 0.01]. In multivariate log regression analysis chronic clopidogrel treatment was an independent predictor of stent thrombosis [OR=2.6 (95%CI 1.2–5.6), p=0.001]. Patients sustaining ACS while on chronic clopidogrel treatment are at higher risk for in-hospital and 30-day adverse outcomes, including stent thrombosis.
KW - ACS
KW - Chronic clopidogrel therapy
KW - Stent thrombosis
UR - http://www.scopus.com/inward/record.url?scp=84957583448&partnerID=8YFLogxK
U2 - 10.1160/TH15-05-0384
DO - 10.1160/TH15-05-0384
M3 - Article
C2 - 26446379
AN - SCOPUS:84957583448
SN - 0340-6245
VL - 115
SP - 433
EP - 438
JO - Thrombosis and Haemostasis
JF - Thrombosis and Haemostasis
IS - 2
ER -