The selection process was showed in Fig. 1. The Beijing Medicare database contains medical data of about 16 million people, including about 990,000 patients with diabetes and a history of taking antidiabetic medicines. Among them, 18,799 patients had a record of PCI surgery in 2014–2016. Among them, 13,693 patients have continuous aspirin withdrawal records in the medicare system. After excluding patients with a survival time of less than one year or no continuous clopidogrel medication withdrawal records, the patients were divided into two groups, one group of 9,116 patients receiving consecutive clopidogrel for one year or more, and another group of 3290 patients receiving consecutive clopidogrel less than one year.
Demographics Of Drugs Treatment
We summarized the medication situation of the two groups of patients as showed in Table 1. Classifications of drugs contains antidiabetic medicine(Thiazolidinediones, α-glucosidase inhibitors, metformin, sulfonylureas, DPP-4 inhibitors, glinides, insulin), antihypertensive medicine(ARB/ACEI, CCB, β-receptor inhibitors, diuretic), related cardiovascular medicine(statin, nitrate, proton pump inhibitors). In group of patients receiving clopidogrel less than 1 years, 4.5% patients treated with TZD, 53.4% with α-glucosidase inhibitors, 43.3% with metformin, 6.5% with glinides, 25.2% with sulfonylureas, 0.5% with DPP-4i, 32.8% with insulin, 63.4% with ARB/ACEI, 48.4% with CCB, 72.8% with β-receptor inhibitors, 19.1% with diuretic, 93.4% with statin, 0.5% with ticagrelor, 50% with nitrate, 16.5% with PPI more than 1 year. There are 7.0% patients treated with TZD, 22.2% with α-glucosidase inhibitors, 23.2% with metformin, 8.2% with glinides, 17.2% with sulfonylureas, 21.2% with ARB/ACEI, 23.3% with CCB, 17.4% with β-receptor inhibitors, 25.4% with diuretic, 6.2% with statin, 3.5% with ticagrelor, 38.4% with nitrate, 43.9% with PPI less than one year. There are 88.5% patients without treated with TZD, 24.3% without α-glucosidase inhibitors, 33.5% without metformin, 85.4% without glinides, 57.6% without sulfonylureas, 15.3% without ARB/ACEI, 28.4% without CCB, 9.8% without β-receptor inhibitors, 55.4% without diuretic, 0.3% without statin, 96.0% without ticagrelor, 11.6% without nitrate, 39.6% without PPI.
In the group of patients receiving clopidogrel more than one years, 4.0% patients treated with TZD, 55.6% with α-glucosidase inhibitors, 45.5% with metformin, 6.7% with glinides, 26% with sulfonylureas, 65.2% with ARB/ACEI, 52% with CCB, 77.3% with β-receptor inhibitors, 19.4% with diuretic, 97% with statin, 0.1% with ticagrelor, 60% with nitrate, 17.8% with PPI more than one year. There are 7.4% patients treated with TZD, 21.1% with α-glucosidase inhibitors, 21.3% with metformin, 8.2% with glinides, 16.4% with sulfonylureas, 18.7% with ARB/ACEI, 21% with CCB, 13.1% with β-receptor inhibitors, 24.6% with diuretic, 2.7% with statin, 0.9% with ticagrelor, 31.2% with nitrate, 41.7% with PPI less than one year.
There are 88.6% patients without treated with TZD, 23.3% without α-glucosidase inhibitors, 33.3% without metformin, 85.1% without glinides, 57.6% without sulfonylureas, 16% without ARB/ACEI, 27% without CCB, 9.7% without β-receptor inhibitors, 56.1% without diuretic, 0.3% without statin, 99% without ticagrelor, 8.9% without nitrate, 40.6% without PPI.
Mortality And Incidence Of Recurrent Myocardial Infarction And Hospitalization
The mortality was lower in patients treated with clopidogrel more than one year compared with the group treated with clopidogrel less than one year(4.6% vs 7.7%, HR, 0.57[95%CI, 0.49–0.67], P < 0.0001)(Fig. 2). The incidence of myocardial infarction was lower in patients treated with clopidogrel more than one year compared with patients treated with clopidogrel less than one year(8.2% vs 10.1%, HR, 0.79[95%CI, 0.68–0.93], P = 0.0035)(Fig. 3). However, there were no significant differences in the incidence of all-cause re-hospitalization(P = 0.7529), diabetes-related re-hospitalization(P = 0.9727) and cerebrovascular re-hospitalization(P = 0.2958)(Fig. 4–6).
Incidence Of Angina And Revascularization
The rate of angina and revascularization was 35.8% and 54.5% in long-term dual anti-platelet therapy group compared with 31.1% and 51.8% in placebo group(HR, 1.18[95%CI, 1.10–1.27], P < 0.0001]) (HR, 1.07[95%CI, 1.01–1.13], P = 0.02])(Fig. 7–8). Long-term combination of aspirin and clopidogrel could cause higher risks of angina and revascularization.