Duration of DAPT in a Patient With PAD and ACS

Case Background

A 62-year-old gentleman presents to the outpatient office for a regular follow-up visit. He suffered an acute inferior wall myocardial infarction 11 months ago, requiring stenting of his mid-right coronary artery with an everolimus-eluting stent. He had mild nonobstructive coronary artery disease in the left circumflex and left anterior descending arteries. He smoked half a pack of cigarettes per day for 20 years and quit smoking after the myocardial infarction. He is overweight (body mass index of 28 kg/m2) and is being managed medically for diabetes, hypertension, and dyslipidemia. He also has a history of left lower extremity intermittent claudication with an ankle-brachial index of 0.70 and is managed with pharmacotherapy and a supervised exercise program. His medications include aspirin 81 mg daily, clopidogrel 75 mg daily, atorvastatin 80 mg daily, lisinopril 20 mg daily, carvedilol 25 mg twice daily, pantoprazole 40 mg daily, and metformin 500 mg twice daily. His blood pressure today is 122/68 mmHg with a pulse of 62 bpm. His physical examination is otherwise unremarkable. He denies any chest pain, palpitations, or shortness of breath. His echocardiogram done 3 months ago demonstrates inferior wall akinesis with a left ventricular ejection fraction of 55%. His echocardiogram demonstrates sinus rhythm with Q waves in leads II, III, and aVF. His hemoglobin A1c is 7.5%, and low-density lipoprotein is 68 mg/dl. He feels well, goes for weekly salsa classes with his wife, and is able to walk 3-4 city blocks without any claudication, chest discomfort, or dyspnea.

He was told by his primary care doctor that he can stop his clopidogrel 12 months after the stent implantation.

Which recommendation would you make to this patient?

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