SCAI: Diabetics' Stent Outcome Improves with Extended Clopidogrel

ORLANDO, May 11 -- Be they bare-metal or drug-eluting, stents led to a better outcome for diabetic coronary-disease patients when augmented by clopidogrel (Plavix) for more than six months, researchers here reported.

And for those patients who received drug-eluting stents, stopping clopidogrel was not associated with an increased risk of death or myocardial infarction, said Somjot Brar, M.D., of Kaiser-Permanente of Los Angeles at the Society of Cardiovascular Angiography and Interventions meeting.

"This is contrary to the findings of other registry trials that have reported an increase in events when clopidogrel was discontinued," he said. "We are not sure why this occurred, but diabetic patients remain a largely untested cohort, which may be a factor."

The retrospective analysis included data from 671 diabetic patients who underwent stenting with bare-mental or drug-eluting stents from 2002 through 2005 and who were event-free six months post-procedure.

Of those patients, 221 received bare metal stents and 450 received drug-eluting stents -- either the sirolimus-eluting Cypher stent or the paclitaxel-eluting Taxus stent.

The 323 clopidogrel users-both bare-metal and drug-eluting stent patients-and 127 non-users were followed for 18 months.

Among the findings:

• The bare-metal and drug-eluting stent groups were similar except for age and LDL cholesterol. The drug-eluting stent patients were younger (P[@portabletext/react] Unknown block type "column", specify a component for it in the `components.types` prop

Carl L. Tommaso, M.D., of Rush Medical College in Chicago, commented that data were interesting, but "confusing because they do appear to contradict published data."

Dr. Tommaso, who chaired the abstract session where the diabetes-stent data were presented, added that the weight of the evidence favors extended use of clopidogrel "but the question that we have to answer is: how long and for
which stent?"