risk of discontinuation of clopidogrel after 1 month following bare-metal stents: a propensity-score adjusted comparison with continued administration of clopidogrel after drug-eluting stents

In patients at high risk for bleeding undergoing percutaneous coronary intervention (pci) the use of bare-metal-stent (bms) is considered an option that allows discontinuation of clopidogrel after 4 weeks. we sought to investigate the risk of early discontinuation of clopidogrel in patients with bms as compared with a 6-month course of clopidogrel after des in patients with or without high on-treatment platelet reactivity (htpr). in 765 consecutive patients undergoing pci after loading with clopidogrel 600 mg, htpr was tested by optical aggregometry and defined as residual platelet reactivity > 14%. on top of aspirin 100 mg, patients received clopidogrel 75 mg for 4 weeks after bms or 6 months after des. the primary endpoint was all-cause mortality or myocardial infarction (mi) during 1 year. the 1-year incidence of death or mi was 3.5% with bms (n = 484), 0.9% with des and no htpr (n = 211), and 7.1% with des and htpr (n = 70; p = 0.03). landmark analyses for the first 6 months demonstrated that the risk of patients receiving bms was similar as in patients receiving a des with htpr during this period (2.3 vs. 2.9%) but lowest in patients receiving a des without htpr (0.5%). the incidence of bleeding was similar in all three groups. these findings did not change after propensity score adjustment for stent type. after discontinuation of clopidogrel at 1 month, patients treated with bms are at higher risk for death or mi than patients treated with a des and sufficiently responding to clopidogrel planned for 6 months. clinicaltrials.gov number nct00457236