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Risk of Late Events Higher with Drug-Eluting Stents

Patients with drug-eluting stents should stay on clopidogrel to reduce the risk of late events

TUESDAY, Dec. 5 (HealthDay News) -- In patients with drug-eluting stents, but not those with bare-metal stents, extended clopidogrel and aspirin use may be needed to reduce the risk of late events such as cardiac death or myocardial infarction, according to two reports published in the Dec. 19 issue of the Journal of the American College of Cardiology and early online Dec. 5 in the Journal of the American Medical Association. An advisory panel to the U.S. Food and Drug Administration is scheduled to review the safety of drug-eluting stents this week.

Matthias Pfisterer, M.D., of the University Hospital and Bruderholzspital in Basel, Switzerland, and colleagues studied 746 patients with either drug-eluting or bare-metal stents. They found that cardiac death or heart attack occurred in 4.9 percent of drug-eluting stent patients at seven to 18 months after the discontinuation of clopidogrel compared to 1.3 percent of bare-metal stent patients.

Eric L. Eisenstein, D.B.A., of Duke University Medical Center in Durham, N.C., studied 4,666 patients with either drug-eluting or bare-metal stents. In drug-eluting stent patients, they found that those taking clopidogrel had a significantly lower two-year death rate than those not taking clopidogrel (2 percent versus 5.3 percent). In bare-metal stent patients, however, they found no significant difference in death rates between those taking clopidogrel and those not taking it (3.7 percent versus 4.5 percent).

"These findings have led us to the view that patients with drug-eluting stents should remain on clopidogrel and aspirin if at all possible until adequate studies are completed," state the authors of an accompanying editorial in the Journal of the American College of Cardiology.

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Abstract (JAMA)
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