Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark.
Eur Heart J. 2012 Oct;33(20):2527-34. doi: 10.1093/eurheartj/ehs202. Epub 2012 Jul 12.
The benefit of extending clopidogrel treatment beyond the 12-month period recommended in current guidelines after myocardial infarction (MI) is debated. We analysed the risk of adverse cardiovascular outcomes after discontinuation of 12 months of clopidogrel treatment.
This Danish retrospective nationwide study included all patients treated with clopidogrel after discharge from a first-time MI during 2004-09. The risk of death or recurrent MI after the discontinuation of clopidogrel was studied by multivariable Poisson regression models. Patients treated with and without percutaneous coronary intervention (PCI) were analysed separately. The follow-up was 18 months. Of the 29,268 patients included, 3214 (11.0%) experienced death or recurrent MI. There were 9819 (33.6%) patients treated only medically and 19,449 (66.4%) patients treated with PCI. Twelve months after the index MI, for patients treated only medically, the risk of death or recurrent MI in the first 90-day period of clopidogrel discontinuation was 1.07 (0.65-1.76; P= 0.79) [adjusted incidence rate ratio (IRR) and 95% confidence interval] compared with the next 90-day period of discontinuation. For patients treated with PCI, the corresponding IRR was 1.59 (1.11-2.30; P= 0.013). The risk of recurrent MI yielded an IRR of 0.77 (0.36-1.67; P= 0.51) for patients treated only medically and 1.87 (1.11-3.15; P= 0.019) for PCI-treated patients.
Discontinuation of clopidogrel 12 months after MI is associated with an increased risk of death or recurrent MI in the first 90 days of discontinuation compared with the next 90-day period of discontinuation for patients treated with PCI, but not for patients not treated with PCI.
在心肌梗死（MI）后，延长氯吡格雷治疗时间超过目前指南推荐的 12 个月的获益存在争议。我们分析了停止 12 个月氯吡格雷治疗后不良心血管结局的风险。
这是一项丹麦的回顾性全国性研究，纳入了 2004 年至 2009 年期间首次 MI 出院后接受氯吡格雷治疗的所有患者。通过多变量泊松回归模型研究了停止氯吡格雷治疗后死亡或再发 MI 的风险。分别分析了接受和未接受经皮冠状动脉介入治疗（PCI）的患者。随访时间为 18 个月。在纳入的 29268 例患者中，有 3214 例（11.0%）发生死亡或再发 MI。仅接受药物治疗的患者有 9819 例（33.6%），接受 PCI 治疗的患者有 19449 例（66.4%）。在 MI 后 12 个月，对于仅接受药物治疗的患者，氯吡格雷停药后前 90 天的死亡或再发 MI 的风险为 1.07（0.65-1.76；P=0.79）[调整后发病率比（IRR）和 95%置信区间]与随后的 90 天停药期相比。对于接受 PCI 治疗的患者，相应的 IRR 为 1.59（1.11-2.30；P=0.013）。对于仅接受药物治疗的患者，再发 MI 的风险为 0.77（0.36-1.67；P=0.51），对于接受 PCI 治疗的患者，风险为 1.87（1.11-3.15；P=0.019）。
与 PCI 治疗患者停药后接下来的 90 天相比，MI 后 12 个月停止氯吡格雷治疗与停药后前 90 天的死亡或再发 MI 风险增加相关，但对于未接受 PCI 治疗的患者则不然。
