Efficacy and safety of clopidogrel pretreatment before percutaneous coronary intervention with and without glycoprotein IIb/IIIa inhibitor use - 09/08/11
, Hussam N. Hamdalla, MD b, Shamir R. Mehta, MD c, Keith A.A. Fox, MBChB d, Eric J. Topol, MD e, Steven R. Steinhubl, MD b, Christopher P. Cannon, MD aRésumé |
Background |
Clopidogrel pretreatment before percutaneous coronary intervention (PCI) has been shown to reduce the risk of death and ischemic complications after PCI. However, the need for clopidogrel pretreatment is debated in patients receiving a glycoprotein IIb/IIIa inhibitor (GPI).
Methods |
We performed a collaborative meta-analysis of the results of 3 randomized trials of clopidogrel pretreatment: PCI-CURE, CREDO, and PCI-CLARITY. Patients were stratified based on GPI use at the time of PCI (a postrandomization subgroup analysis). Odds ratios (ORs) and 95% CIs for the effect of clopidogrel pretreatment versus placebo pretreatment on the incidence of cardiovascular death, myocardial infarction (MI), or stroke for up to 30 days after PCI were calculated for each trial within each GPI stratum and were combined using a random effects model.
Results |
Six thousand three hundred twenty-five patients were included, 32.4% of whom received a GPI. There was a consistent benefit of clopidogrel pretreatment in reducing the incidence of cardiovascular death, MI, or stroke after PCI both in patients who did not receive a GPI (OR 0.72, 95% CI 0.53-0.98, P = .03) and in those who did (OR 0.69, 95% CI 0.47-1.00, P = .05). There was no evidence of heterogeneity in the benefit of clopidogrel pretreatment between GPI use strata (P = .85 for heterogeneity). Clopidogrel pretreatment was not associated with a significant excess of TIMI major or minor bleeding, either in those who did not receive a GPI (OR 1.20, 95% CI 0.76-1.92) or in those who did (OR 1.22, 95% CI 0.71-2.09) (P = .97 for heterogeneity).
Conclusion |
Clopidogrel pretreatment before PCI is beneficial and safe regardless of whether a GPI is used at the time of PCI.
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| The parent clinical trials were supported by grants from the Bristol-Myers Squibb/sanofi-aventis, Princeton and Bridgewater, NJ partnership. Dr Sabatine has received research grant support from sanofi-aventis and Schering-Plough; honoraria from Bristol-Myers Squibb and sanofi-aventis; and served on scientific advisory boards for Bristol-Myers Squibb, sanofi-aventis, and Daiichi-Sankyo. Dr Hamdalla has received honoraria from Novartis. Dr Mehta has received research grant support from Bristol-Myers Squibb, sanofi-aventis, and GlaxoSmithKline; honoraria from Bristol-Myers Squibb, sanofi-aventis, GlaxoSmithKline, Eli Lilly, and Boston Scientific; and served on scientific advisory boards for sanofi-aventis, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly, and Boston Scientific. Dr Fox has received research grant support from sanofi-aventis and Bristol-Myers Squibb, received honoraria from sanofi-aventis and Bristol-Myers Squibb, served on Speakers Bureau for sanofi-faventis and Bristol-Myers Squibb, and served on scientific advisory boards for sanofi-aventis. Dr Topol has received research grant support from sanofi-aventis. Dr Steinhubl has received research grant support from the Medicines Co and Eli Lilly/Daiichi-Sankyo; and served on scientific advisory boards for sanofi-aventis, the Medicines Co, AstraZeneca, Eli Lilly, Daiichi-Sankyo, and Cardax. Dr Cannon has received research grant support from Accumetrics, AstraZeneca, Merck, Merck/Schering Plough, and Schering Plough. |
Vol 155 - N° 5
P. 910-917 - mai 2008 Retour au numéro
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