European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(21):2345; doi:10.1093/eurheartj/ehi545
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Management and prevention of thrombotic stent occlusion
Department of Cardiology
Faculty of Health Sciences
Soroka University Medical Center
Ben Gurion University of the Negev
Beer Sheva 84101
Israel
Tel: +972 8 640 0951
Fax: +972 8 623 8248
E-mail address: arikwt{at}bgu.ac.il
We read with a great interest, the paper by Wenaweser et al.1 who report the efficacy and outcome of emergency percutaneous coronary interventions in patients with stent thrombosis.
Recently, we published our data on 1519 consecutive patients who underwent 2020 stent implantations and were discharged on dual anti-platelet therapy. We compared the short- and long-term risks of thrombotic stent occlusion (TSO) and mortality in patients given clopidogrel or ticlopidine.2,3
The rates of TSO during the first year of follow-up, in our study, were 1.8, 0.7, and 2.8% in the whole group, the ticlopidine group and the clopidogrel group (P<0.01). A multivariate model showed that clopidogrel (vs. ticlopidine) treatment was the sole predictor of TSO (OR=5.4, 95% CI=1.2–24.1, P=0.028). Of even greater concern, clopidogrel treatment was associated with an increased risk of 1-year mortality (OR=1.8, 95% CI=1.2–2.8). Our data are in agreement with those published by Mueller et al.4 who reported that the extended follow-up data of their initial randomized trial which compared clopidogrel with ticlopidine after stenting. Similar to our findings, these investigators reported a significantly higher rate of mortality, both overall and cardiovascular, in the clopidogrel arm.
Wenaweser et al.1 report a prevalence of 1.6% of stent thrombosis, a rate that is similar to ours. Clopidogrel was used in many more of their TSO patients than ticlopidine (86 and 14%, respectively).
While the focus of the study of Wenaweser et al.1 was on the treatment of TSO, we believe that in light of the previous findings, it would be of great interest to know whether Wenaweser et al.1 could report the rates of TSO in their clopidogrel- and ticlopidine-treated patients, respectively. Such information from another well-studied cohort may shed further light on the potential role of ticlopidine vs. clopidogrel in the long-term prevention of TSO.
References
- Wenaweser P, Rey C, Eberli FR, Togni M, Tuller D, Locher S, Remondino A, Seiler C, Hess OM, Meier B, Windecker S. Stent thrombosis following bare-metal stent implantation: success of emergency percutaneous coronary intervention and predictors of adverse outcome. Eur Heart J 2005;26(12):1180–1187.
[Abstract/Free Full Text] - Wolak A, Amit G, Cafri C, Gilutz H, Ilia R, Zahger D. Increased long term rates of stent thrombosis and mortality in patients given clopidogrel as compared to ticlopidine following coronary stent implantation. Int J Cardiol 2005;103(3):293–297.[CrossRef][Web of Science][Medline]
- Wolak A, Amit G, Cafri C, Gilutz H, Ilia R, Zahger D. Clopidogrel is associated with increased rates of 1-year stent thrombosis and mortality as compared with ticlopidine following coronary stent implantation. Eur Heart J 2004;August/September (suppl.).
- Mueller C, Roskamm H, Neumann FJ, Hunziker P, Marsch S, Perruchoud A, Buettner HJ. A randomized comparison of clopidogrel and aspirin versus ticlopidine and aspirin after the placement of coronary artery stents. J Am Coll Cardiol 2003;41(6):969–973.
[Abstract/Free Full Text]
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