Author + information
- Received September 12, 2007
- Revision received December 12, 2007
- Accepted January 6, 2008
- Published online June 10, 2008.
- Somjot S. Brar, MD⁎,⁎ (, )
- John Kim, MD†,
- Simerjeet K. Brar, BS†,
- Ray Zadegan, MD†,
- Michael Ree, BS†,
- In-Lu A. Liu, MS‡,
- Prakash Mansukhani, MD†,
- Vicken Aharonian, MD†,
- Ric Hyett, BS† and
- Albert Yuh-Jer Shen, MD†,§
- ↵⁎Reprint requests and correspondence:
Dr. Somjot S. Brar, Center for Interventional Vascular Therapy, Columbia University Medical Center, 161 Fort Washington Avenue, 5th Floor, New York, New York 10032.
Objectives The purpose of this study was to determine whether long-term clinical outcomes differed between bare-metal stents (BMS) and drug-eluting stents (DES) by duration of clopidogrel use among diabetic patients.
Background There is concern that DES are associated with late adverse events such as death and myocardial infarction (MI) secondary to stent thrombosis. However, data on outcomes in diabetic patients remain limited.
Methods We identified 749 patients with diabetes mellitus who underwent stent implantation with either BMS (n = 251) or DES (n = 498) from October 2002 to December 2004. We performed survival analysis on the full cohort and on those event-free from death, MI, or repeat revascularization at 6 months (n = 671).
Results By clopidogrel duration, the event rate for death or MI was 3.2% in the >9-month group, 9.4% in the 6- to 9-month group, and 16.5% in the <6-month group, p < 0.001. For death alone, the event rate was 0.5% in the >9-month group, 4.3% in the 6- to 9-month group, and 10.0% in the <6-month group, p < 0.001. When taking BMS clopidogrel non-users as a referent in the multivariate analysis, the hazard ratio (95% confidence interval [CI]) for death and nonfatal MI for DES clopidogrel users, DES clopidogrel nonusers, and BMS clopidogrel users were: HR 0.22 (95% CI 0.08 to 0.62, p = 0.005), HR 0.39 (95% CI 0.13 to 1.13, p = 0.08), and HR 0.25 (95% CI 0.08 to 0.81, p = 0.02), respectively.
Conclusions Longer duration of clopidogrel use was associated with a lower incidence of death or MI in both the BMS and DES groups. Among clopidogrel nonusers, the incidence of death/MI or death did not differ by stent type.
Funding was provided by Kaiser Permanente Southern California and Boston Scientific, Inc. Drs. Brar and Shen received research grant support from Boston Scientific. The administration of Kaiser Permanente or Boston Scientific was not involved in the study design, analysis, or interpretation and had no role in the drafting of the manuscript.
- Received September 12, 2007.
- Revision received December 12, 2007.
- Accepted January 6, 2008.
- American College of Cardiology Foundation