Continuing clopidogrel treatment beyond 12 months may decrease very late death or myocardial infarction (MI) in diabetes mellitus patients with a first generation drug-eluting stent, according to a study published Aug. 31 in the Journal of the American College of Cardiology.

Using data from the Veterans Health Administration, Arun K. Thukkani, MD, PhD, FACC, et al., analyzed the effect of prolonging clopidogrel therapy in patients who underwent percutaneous coronary intervention (PCI) between 2002 and 2006. Of the 28,849 patients, 9,905 had diabetes mellitus treated with oral medications or diet and 2,612 had diabetes mellitus treated with insulin. The primary endpoint was the risk of all-cause death or MI.

The results of the study showed that extending the use of clopidogrel treatment greater than 12 months in diabetes mellitus patients with a drug-eluting stent who have not experienced adverse events following PCI can lower the risk of very late death or MI. No benefit was seen in diabetes mellitus patients with bare-metal stents or those patients without diabetes mellitus who received either type of stent.

The authors of the study emphasize that “large randomized trials of first- and second-generation [drug-eluting stents] should examine outcomes by subgroups of [diabetes mellitus patients] to further assess …” the results of this study.

“The inability to show a benefit after bare-metal stent implantation or in several [randomized clinical trials] after newer-generation [drug-eluting stent] implantation weakens support for prolonged [dual antiplatelet therapy] for diabetic patients undergoing stenting in current practice,” states John A. Bittl, MD, FACC, in an accompanying editorial comment. “Additional investigation is needed to define the pathogenetic links between the metabolic changes and clinical manifestations of diabetes mellitus.”

Keywords: Diabetes Mellitus, Diet, Drug-Eluting Stents, Insulin, Myocardial Infarction, Percutaneous Coronary Intervention, Stents, Ticlopidine, Veterans Health

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