Clopidogrel pretreatment of benefit in PCI, data suggest
Pretreatment with clopidogrel in patients with recent ST-segment elevation myocardial infarction (STEMI) undergoing a percutaneous coronary intervention (PCI) reduces the incidence of cardiovascular death or ischaemic complications without a significant increase in bleeding, researchers suggest.
Marc Sabatine, of Brigham and Women’s Hospital and Harvard Medical
School, Boston, and colleagues analysed data from 1,863 patients undergoing
PCI and compared clopidogrel pretreatment with treatment initiated at
the time of PCI.
Patients were randomised to receive aspirin plus either clopidogrel (300mg
loading dose followed by 75mg a day) or placebo, which was initiated with
fibrinolysis and given until angiography (two to eight days after initiation
of the study drug). Patients undergoing coronary stenting received open-label
clopidogrel after a diagnostic angiogram (ie, treatment was initiated
at the time of PCI).
The researchers found that incidence of cardiovascular death, MI or stroke
following PCI was reduced by 46 per cent following clopidogrel pretreatment
(P=0.008)
.
Pretreatment also reduced the incidence of MI or stroke before PCI (adjusted
odds ratio 0.62; P=0.03). The researchers estimate that, overall,
23 patients would need pretreatment with clopidogrel to prevent one cardiovascular
death, MI or stroke. No increase in major or minor bleeding was observed.
“These data add further support to the early use of clopidogrel
in STEMI and the broader strategy of clopidogrel pretreatment in patients
undergoing PCI,” the researchers conclude.
The study is published in this week’s issue
of JAMA (2005;294:1224). |
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