Ancillary Research

Collaborative Research on the Clinical Effectiveness and Long-term Outcomes of Stents in Coronary Interventions

PI: David J. Magid, MD

Clinical trials have demonstrated the efficacy of clopidogrel for reducing cardiac events following coronary stent implantation. Recent reports of increased stent thrombosis occurring more than six months after drug-eluting stent (DES) implantation, a phenomenon not detected in the relatively short-term randomized efficacy clinical trials, have led to calls for more research on the safety and effectiveness of coronary stents in actual clinical practice. In response to concerns about increased stent thrombosis in patients receiving DES, several professional societies collaborated to develop a joint statement recommending 12 months of clopidogrel therapy following DES placement. However, the evidence base for this recommendation remains limited.

In considering the appropriate length of clopidogrel therapy after DES placement, it is critical to weigh the possible benefits of extended therapy against the higher medication costs and increased risk for therapy-related complications. The long-term rates of bleeding complications in patients receiving adjuvant clopidogrel therapy following stent implantation and the extent to which a rebound thrombotic effect occurs following clopidogrel cessation in actual clinical practice are unknown. We will address this gap in knowledge by conducting a cohort study that will assess the risks, and benefits associated with different lengths of clopidogrel therapy for over 8,000 patients receiving coronary stents in three large geographically distinct health delivery systems.

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