Clopidogrel may improve outcome in acute coronary syndrome
Adding clopidogrel to standard aspirin therapy improves
outcome in patients with acute coronary syndromes, researchers have found.
Dr Shamir Mehta, division of cardiology, McMaster
University, Hamilton, Canada, and colleagues compared the effects of clopidogrel
and placebo in 2,658 patients undergoing percutaneous coronary intervention
(PCI). Patients were treated for a mean of six days before PCI and for
a mean of eight months afterwards.
Clopidogrel was found to reduce the risk of cardiovascular
death or myocardial infarction by about a third, compared with placebo.
The lower rate of events was seen as early as two days after PCI. Benefit
continued until the end of follow-up.
“We have shown that when clopidogrel is combined
with aspirin and given before PCI, there are significant and clinically
relevant further reductions in important cardiac events,” they conclude
(Lancet 2001;358: 527).
However, in an accompanying leading article (ibid,
p520), Dr Rod Stables, Royal Liverpool University Hospital, questions
the results. He says that beyond 30 days post-PCI there is no significant
advantage of clopidogrel over placebo in rate of cardiovascular death
or myocardial infarction and that the trial results only indicate an advantage
because they include data on events occurring soon after PCI.
“Clopidogrel is in routine use in the weeks following
PCI and the value of extended therapy is best judged in terms of events
from 30 days post-PCI to the end of follow-up,” he says.
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