Time for science to catch up with clinical practice?

Siddiqi et al. performed a retrospective analysis of the large Veterans database to explore the effect of clopidogrel prolongation beyond 12 months compared with 12 months or less after coronary stenting (1). Patients treated between 2002 and 2006 were divided in two groups: normal renal function (n=18,162) or chronic kidney disease (CKD, n=4,880) based on an estimated glomerular filtration rate (eGFR) cut-off of ≥ or <60 mL/min, respectively. A further stratification was made to compare patients treated with bare metal stents (BMS) and those treated with drug-eluting stents (DES). Outcomes were evaluated in patients free from ischemic or bleeding events within the first 12 months after percutaneous coronary intervention (PCI), at a follow-up ranging from 1 to 4 years after PCI. The primary endpoint was the combined outcome of death or acute myocardial infarction (MI), which was significantly increased in patients with CKD in both DES and BMS subgroups. However, CKD was also associated with an increased risk of disabling or life-threatening bleeding after DES and BMS implantation.