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Clopidogrel treatment before percutaneous coronary intervention reduces adverse cardiac events
1Department of Cardiology, University Hospital, S-581 85, Link ping, Sweden. ulf.berglund@lio.se
Insights
Pre-treatment with clopidogrel and aspirin before percutaneous coronary intervention (PCI) significantly reduced adverse cardiac events, including myocardial infarction and reintervention, while also proving safe and cost-effective.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Platelet inhibition is crucial for reducing adverse cardiac events during percutaneous coronary intervention (PCI).
- Limited data exist on the combined use of aspirin and clopidogrel (a platelet adenosine diphosphate-receptor inhibitor) prior to PCI.
Purpose of the Study:
- To evaluate the efficacy and safety of pre-treatment with aspirin plus clopidogrel compared to aspirin alone before PCI.
- To assess the impact on in-hospital adverse cardiac events and costs.
Main Methods:
- A non-randomized study comparing 706 patients receiving aspirin plus clopidogrel (375 mg) before PCI.
- A control group of 724 patients received aspirin pre-treatment only.
- Baseline characteristics were balanced between the groups.
Main Results:
- Pre-treatment with clopidogrel significantly reduced the composite endpoint of death, myocardial infarction, or urgent revascularization by 41% (8.2% vs. 4.8%, p=0.010).
- This reduction was primarily driven by decreased rates of myocardial infarction (7.2% vs. 4.4%, p=0.024) and percutaneous reintervention (1.2% vs. 0.3%, p=0.039).
- No significant difference in femoral complications was observed; the clopidogrel group demonstrated cost savings.
Conclusions:
- Combining clopidogrel with aspirin before PCI is associated with reduced in-hospital adverse cardiac events.
- This treatment strategy is safe and cost-saving.
Objective:
Platelet inhibition during percutaneous coronary intervention (PCI) generally reduces adverse cardiac events. There are very few data on the combination of aspirin and the platelet adenosine diphosphate-receptor inhibitor clopidogrel given before the intervention.
Design:
In a non-randomized comparison, a total of 706 consecutive patients received clopidogrel 375 mg in addition to aspirin on the day before PCI. The control group consisted of 724 consecutive PCI patients receiving only aspirin pre-treatment.
Results:
The two groups were well balanced regarding baseline characteristics. Pre-treatment with clopidogrel reduced the in-hospital composite of death, myocardial infarction or urgent revascularization by 41% compared to the control (8.2% versus 4.8%, respectively; p = 0.010). This was due to a decreased incidence of myocardial infarction (7.2% versus 4.4%; p = 0.024) and percutaneous reintervention (1.2% versus 0.3%; p = 0.039). There was no difference in femoral complications between the groups. For every patient in the clopidogrel group, there was a cost reduction of SEK 447 ($40 United States currency).
Conclusion:
Clopidogrel treatment in addition to aspirin before PCI was associated with a reduction of in-hospital adverse cardiac events. It was also safe and cost-saving.