Wiederkehr Daniel, Berenson Karina, Casciano Roman, Stern Lee, Makenbaeva Dinara, Mozaffari Essy, Lamerato Lois, Corbelli John
Analytica International, New York, NY, USA.
Curr Med Res Opin. 2009 Sep;25(9):2317-25. doi: 10.1185/03007990903156061.
To determine the association between the discontinuation of clopidogrel therapy prior to 1 year and the risk of acute myocardial infarction (AMI) hospitalization, coronary intervention or all-cause mortality in a cohort of managed-care patients following AMI hospitalization or stent insertion.
This observational cohort study included 1152 patients enrolled in the Health Alliance Plan who were hospitalized for AMI, or who underwent coronary stent placement. Clopidogrel use was assessed using pharmacy claims data. The association between discontinuation of clopidogrel prior to 1 year following the initial ACS event and the primary outcome of AMI hospitalization/procedure was assessed using Cox proportional hazards models. Additionally, an analysis was conducted to determine the association of discontinuation prior to 1 year with a secondary composite outcome of AMI hospitalization/coronary stent procedure or all-cause mortality.
The primary outcome was AMI hospitalization or procedure. The secondary outcome was a composite of AMI hospitalization/ procedure, or all-cause mortality.
Discontinuation of clopidogrel in the total cohort of patients was associated with a significantly higher risk of the primary outcome of AMI hospitalization/ coronary intervention (HR 2.712, 95% CI 1.634-4.502). Consistent with this finding, discontinuation of clopidogrel was also associated with a significantly higher risk of the secondary composite endpoint (HR 1.844, 95% CI 1.281-2.653).
In patients enrolled in an integrated health network, clopidogrel discontinuation prior to 1 year following AMI hospitalization or stent placement is associated with adverse outcomes including greater risk of death, AMI hospitalization or coronary intervention. These results should be interpreted within the context and limitations of observational research, which cannot attribute causality.
确定在急性心肌梗死（AMI）住院或支架置入后的管理式医疗患者队列中，1年内停用氯吡格雷治疗与AMI住院、冠状动脉介入治疗风险或全因死亡率之间的关联。
这项观察性队列研究纳入了1152名参加健康联盟计划的患者，这些患者因AMI住院或接受了冠状动脉支架置入术。使用药房报销数据评估氯吡格雷的使用情况。使用Cox比例风险模型评估首次急性冠状动脉综合征（ACS）事件后1年内停用氯吡格雷与AMI住院/手术的主要结局之间的关联。此外，还进行了一项分析，以确定1年内停用氯吡格雷与AMI住院/冠状动脉支架手术或全因死亡率的次要复合结局之间的关联。
主要结局是AMI住院或手术。次要结局是AMI住院/手术或全因死亡率的复合指标。
在整个患者队列中，停用氯吡格雷与AMI住院/冠状动脉介入治疗的主要结局风险显著升高相关（风险比[HR]2.712，95%置信区间[CI]1.634 - 4.502）。与这一发现一致，停用氯吡格雷也与次要复合终点的风险显著升高相关（HR 1.844，95% CI 1.281 - 2.653）。
在综合健康网络登记的患者中，AMI住院或支架置入后1年内停用氯吡格雷与不良结局相关，包括死亡、AMI住院或冠状动脉介入治疗的风险增加。这些结果应在观察性研究的背景和局限性内进行解释，观察性研究无法确定因果关系。
