Prolonged clopidogrel use improves clinical outcomes following drug eluting but not bare metal stent implantation
Bibliographic record
Abstract
Purpose: Current guidelines recommend clopidogrel for 6-12 months following drug eluting stent (DES) implantation. The role of clopidogrel beyond 12 months is unclear. Methods: We linked hospital administrative, community pharmacy and cardiac revascularization data to determine clopidogrel use and outcomes for all patients receiving a coronary stent in British Columbia 2004 - 2006 with follow-up to 5 years. Cox proportional hazard regression analysis was performed to determine the effect of prolonged clopidogrel use (>12 months) on outcomes. Patients who died ≤12 months from index stent placement were excluded. Results: 15,629 patients were included in the study. Of 3,599 patients who received at least 1 DES and 12030 patients who received only bare metal stents (BMS), 1326 (37%) and 2121 (18%) respectively filled a prescription for clopidogrel >12 months from the index procedure. The mean duration of clopidogrel prescription in patients who received clopidogrel >12 months was 406±35 days in the DES group and 407±37 days in the BMS group, compared with 217±115 days (p<0.0001) and 117±116 days (p<0.0001) respectively for those who did not. Compared with ≤12 months clopidogrel, prolonged clopidogrel use was associated with a reduction in mortality (HR 0.67, 95% CI [0.46–0.98], p=0.038), mortality and readmission for myocardial infarction combined (HR 0.70, 95% CI [0.54–0.92], p=0.01) and an indication of a reduction in readmission for myocardial infarction alone (HR 0.70, 95% CI [0.49–1.00], p=0.051) in patients treated with DES, but not with BMS alone. Conclusions: In contrast to BMS, clopidogrel use beyond 12 months following DES implantation was associated with improved clinical outcomes. Our data support a longer duration of clopidogrel therapy for patients treated with DES.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".