Clopidogrel for prevention of major cardiac events after coronary stent implantation: 30-day and 6-month results in patients with smaller stents

Objectives We developed this study to assess the procedural outcome, compli cations, and clinical follow-up in patients treated with different antiplat elet regimens after intracoronary stent implantation with small stents. Thr ee hundred sixty-one consecutive patients, in whom at least one 3.0-mm intr acoronary stent was implanted, were studied. Methods The study was a prospective, observational registry of unselected c onsecutive patients treated in our institution. Patients who underwent sten t implantation between December 1997 and July 1998 were treated with aspiri n and ticlopidine; those who received stents between August 1998 and Februa ry 1999 were treated with aspirin and clopidogrel. Results In the group treated with ticlopidine, there were 190 patients who had 253 lesions treated with 274 stents. Mean age was 59.1 years, 72% were male, 31% had unstable angina, 64% had 1 stent, 36% had >1 stent, and 23% h ad multivessel intervention, in the group treated with clopidogrel, there w ere 171 patients who had 226 lesions treated with 245 stents. Mean age was 60.4 years, 79% were male, 26% had unstable angina, 70% had 1 stent, 30% ha d >1 stent, and 26% had multivessel intervention. Complications at 30 days in the ticlopidine group were death in 1 (0.5%), stent occlusion in 3 (1.6% ; all reopened with repeat angioplasty), non-Q-wave myocardial infarction i n 2 (1%), and urgent revascularization in 4 (2%). Complications at 30 days in the clopidogrel group were noncardiac death in 1 (1.2%), cardiac death i n 1 (1.2%), stent occlusion in 0, non-Q-wave myocardial infarction in 3 (1. 8%), and urgent revascularization in O. Follow-vp was available in 100% of patients in both groups (mean 253 +/- 75 days in the ticlopidine group, 198 +/- 53 days in the clopidogrel group). Complications at >30 days in the ti clopidine group were death in 1 and clinical restenosis in 11 (5.8%); 1 add itional patient had on admission with unstable angina to the local hospital . Hence, re-current angina as a consequence of target lesion restenosis occ urred in 5.8%. Complications at >30 days in the clopidogrel group were deat h in O and clinical restenosis in 8 (4.7%); 2 additional patients were admi tted with unstable angina to the local hospital, and 1 patient had a myocar dial infarction 164 days after stent implantation. Hence, recurrent angina as a consequence of target lesion restenosis occurred in 4.7%. There were n o significant differences in complications between the 2 groups. Conclusions Our observations suggest that clopidogrel con be used instead o f ticlopidine in patients treated with stents with a diameter of less than or equal to 3.0 mm, without any increase in major adverse cardiac events, b oth within the first 30 days and at medium-term follow-vp. Clopidogrel has significant cost advantages over ticlopidine, and carries a superior side-e ffect profile. We suggest that, in combination with aspirin, clopidogrel sh ould replace ticlopidine as standard antiplatelet therapy after intracorona ry stent implantation.