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Timing of Adverse Outcomes After Stenting Identified

Last Updated: April 02, 2009.

 

Drug treatment and timing affects risk of death and heart attack

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Patients with unprotected left main coronary artery stenosis are at highest risk of death or heart attack from one to six months after stenting if they are taking dual antiplatelet therapy and within three months of stopping clopidogrel treatment, with the highest risk being during the first month after stenting, according to a study in the April 7 issue of the Journal of the American College of Cardiology.

THURSDAY, April 2 (HealthDay News) -- Patients with unprotected left main coronary artery (ULMCA) stenosis are at highest risk of death or heart attack from one to six months after stenting if they are taking dual antiplatelet therapy and within three months of stopping clopidogrel treatment, with the highest risk being during the first month after stenting, according to a study in the April 7 issue of the Journal of the American College of Cardiology.

Tullio Palmerini, M.D., from the Universita di Bologna in Italy, and colleagues analyzed follow-up data on 894 patients with ULMCA stenosis who had undergone percutaneous coronary intervention (PCI).

The researchers found that 5.4 percent of patients experienced cardiac death or a myocardial infarction within 30 days of PCI, which the authors note is already known to be the most critical period. Patients were at highest risk 31 to 180 days after PCI, compared with later periods, if they were taking dual antiplatelet therapy (adjusted incidence rate ratio per 10,000 patient-days, 3.64) and the risk was highest in patients with acute coronary syndromes. Patients were also at high risk of these two outcomes during the first 90 days after stopping clopidogrel treatment (adjusted incidence rate ratio per 10,000 patient-days, 4.20).

"In patients with ULMCA stenosis taking dual antiplatelet therapy there is an increased hazard of cardiac mortality and myocardial infarction between 31 and 180 days compared with 181 to 360 days," the authors conclude. "Furthermore, there is an increased hazard of cardiac mortality and myocardial infarction in the first 90 days after stopping clopidogrel."

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